Dermatology toolkit

The following tools may be used in diagnosing and managing patients suffering from a skin condition.

1. Websites

• The Primary Care Dermatology Society (PCDS) website has diagnostic tables, where diagnostic clues including either the history, the site, or the appearance of the rash/lesion can be used to identify a list of differential diagnoses. The diagnostic tables are available for both general dermatology and for  skin lesions.
• The PCDS website A-Z of clinical guidance provides clear descriptions of the clinical features of the skin condition, together with images and management advice.
• The PCDS Desktop Treatment Guide provides quick access to management advice for the common and important skin conditions.
• Dermnetnz was founded in New Zealand, and contains over 2000 searchable topics and printable information in an A-Z format, which can be translated
• The British Association of Dermatologists (BAD), provides clinical guidelines for the management of a range of dermatological conditions

2. Primary Care Treatment Pathways developed by the PCDS

• Acne
• Psoriasis
• Rosacea
• Actinic Keratosis
• Paediatric eczema pathway
• Adult eczema pathway

3. Royal College of General Practitioners (RCGP)

• Psychodermatology: Tips for GPs
  
• RCGP Lyme Disease Toolkit

4. Clinical Knowledge Summaries (CKS)

CKS from National Institute for Health and Care Excellence (NICE) for dermatology conditions.

Specifically, for common dermatology conditions seen in primary care:

• Acne
• Eczema
• Psoriasis
• Skin cancers recognition and referral

5. Guidelines and best practice

Guidelines in Practice and BMJ Best Practice includes summaries of guidelines and implementation of best practice. 

6. Dermatology in Practice

A review-based journal which is free to subscribe to. Quarterly bulletins are produced with an array of clinical articles, practical guides and case studies.

7. Skin of Colour resource

The Centre for Evidence Based Dermatology (CEBD) provides evidence based information of relevance to skin colour.

8. Assessment of disease severity and quality of life

The following tools can be used in clinic to guide treatments and need for specialist referral. 

• Psoriasis Area and Severity Index (PASI)

i. Worksheet from British Association of Dermatologists (BAD)

ii. An easy and useful Psoriasis 360 APP can aid with psoriasis assessment in clinic and includes a PASI calculator (available on android)

• Psoriasis Epidemiology Screening Tool (PEST) for Psoriatic Arthritis. It is recommended that patients with psoriasis who do not have a diagnosis of psoriatic arthritis have an annual screening for arthritis using this validated questionnaire.

• Dermatology Quality of Life Index (DLQI) is a dermatology specific quality of life questionnaire which can be translated to different languages for:

i. Adults

ii. Children

• Urticaria Activity Score (UAS7) is a patient-reported measure over 7 days of the number of wheals and intensity of itching, in those suffering from Chronic Idiopathic Urticaria. It is also available as an APP, SYM TRAC HIVES (android and iOS) 
• Patient Orientated Eczema Measure (POEM) is an eczema severity assessment tool which is available to adults and children to self-complete their eczema symptoms.It is also available as an APP, My Eczema Tracker on android and iOS to enable eczema severity to be assessed over weeks or months.
• Eczema Area and Severity Index (EASI) is a validated scoring system for recording the physical signs of eczema

9. Topical Corticosteroids potency ladder and quantity of application using the Finger Tip Unit (FTU) measure

There are a wide variety of topical corticosteroids available. The BNF has a useful topical corticosteroid potency page to support clinicians with identifying which potency a particular corticosteroid is.

The Finger Tip Unit (FTU) is commonly used to explain the quantity of topical corticosteroid that is to be applied to the skin and guides the clinician around quantities to prescribe. Patient.info have a useful information sheet on the FTU which can be translated into different languages.

10. Emollients (Moisturisers)

These are very important in the treatment of inflammatory and dry skin conditions such as eczema and psoriasis, in which their frequent and liberal use will act to restore the skin’s protective barrier and relieve dryness and itching. They can also be used as a wash (soap substitute). The National Eczema Society has a helpful Emollient Factsheet* which can support the patient and clinician to choose the best emollient for them.

*There are many emollient formularies around the U.K. and clinicians should refer to their local guidance.

The MIMS Emollient Sensitiser table lists emollient brands according to the presence of potential sensitising agents within each preparation.

11. Evidence Based Reviews on skin conditions and their treatments

 The Centre for Evidence Based Dermatology (CEBD) produces free tools and resources of relevance to those who have or research skin conditions.