| GP MANAGEMENT PLAN: dermatitis |
| Patient problems / needs / relevant conditions | Goals – changes to be achieved (if possible) | Required treatments and services including patient actions | Arrangements for treatments/services (when, who, and contact details) |
| 1. General | |||
| Patient’s understanding of dermatitis | Patient to have a clear understanding of dermatitis and the patient’s role in managing the condition | Patient education | GP |
| Diagnosis of dermatitis | Patient to undergo clinical assessment | Acute phase Oedema and crusting Oozing and weeping Chronic phase: Fissuring and scaling lichenification Other features Itch / excoriationHot red skin, Secondary infection, Impairment of thermoregulation Types of eczema Endogenous – intrinsic – types include: Atopic eczema, Discoid eczema, Pompholyx, Seborrhoeic eczema, Asteotic eczema, Pityriasis alba, Actinic dermatitis – extrinsic – types include: Contact dermatitis – primary irritant or allergic contact. Photodermatitis. Phytodermatitis. Photophytodermatitis. Hypostatic or varicose eczema, Lichen Autosensitisation dermatitis In atopic eczema, the skin is dry and itchy. Predisposing factors are: Overwashing / overscrubbing – especially in situations of community Inadequate removal of soap, Low humidity / dry air – central heating; hospital winter diuretics | GP / other specialist |
| Testing in dermatitis | Patient to undergo appropriate clinical testing | Red flags Acute Superimposed bacterial infectionSuperimposed herpes simplex infection – eczema herpeticum Chronic Differentials include Mycosis fungoidesBCCSCC | GP / other specialist |
| Assessment of red flags for dermatitis | Patient to undergo appropriate clinical assessment to exclude serious differential diagnoses of dermatitis | Sleep disturbance, Psychological problems including anxiety and depressionReduced performance at school or work | GP / other specialist |
| Complications | Assessment of complications of dermatitis | Provision of information relevant to the control of allergen exposure. | GPOther specialistPsychologist |
| Control of allergens | Minimisation of symptoms by the control of exposure of patients to allergens identified as triggers for symptoms | Provision of information relevant to control of allergen exposure. | GP Other specialist |
| Avoidance of triggers | Minimisation of symptoms by the control of exposure of patients to allergens identified as triggers for symptoms | Healthy eating pattern, low-fat diet Patient education OR As per Lifescripts action plan | GP / other specialist |
| 2. Lifestyle / conservative management | |||
| Nutrition | Optimising health | Healthy eating pattern, low fat diet Patient education OR As per Lifescripts action plan | GP to monitor Patient to implementDietician to advise |
| Weight | Normal weight to optimise health | The provision of dietary advice aimed at controlled weight loss and the setting of weight loss targets aimed at improving the clinical status of patients who are either overweight or obese Target:BMI ≤ 25Men waist ≤ 94 cmWomen waist ≤ 80 cmMonitorReview 6 monthly | Patient to implementGP to monitorDietician to advise and monitor |
| Physical Activity | Appropriate activity levels to optimise health | Awareness of the benefits of aerobic, and strength and balance training Patient exercise routine incorporating strength / balance and aerobic training The provision of advice and exercise therapy Target: At least 30 minutes walking or equivalent 5 or more days per week | Patient to implementGP to monitor Physiotherapist to advise and monitor |
| Smoking | Complete cessation | Smoking cessation strategy:Consider:- Quit- Medication | Patient to manageGPSmoking cessation advisor |
| Alcohol | Appropriate safe levels of alcohol consumption | Your target:≤ 2 standard drinks per day (men)≤ 1 standard drinks per day (women) Reduce alcohol intakePatient education | Patient to manageGP to advise / monitor |
| 2. Biomedical | |||
| Cholesterol / Lipids | Your target:Cholesterol ≤ 4.0 mmols/LTriglycerides ≤ 2.0 mmol/LLDL-C ≤ 2.5 mmol/LHDL-C ≥ 1.0 mmol/L | Annual check | GP |
| Blood pressure | Your target:< 140/90 | Check every 6 months | GP |
| 3. Medication | |||
| Medication review | Correct use of medications, minimise side effects Ensuring patient awareness and understanding of therapies used in the management of dermatitis: their indications, contra-indications and side effects. | Patient educationReview medications | GP and pharmacist to review and provide education |
| First line therapies | Moisturiser therapies Humectants attract transepidermal water to stratum corneum and retain it thereE.g.GlycerinMacrogolsPropylene glycolUrea Emollients smooth roughened surface of stratum corneum by filling in the spaces between dry skin flakes with oil droplets. Some emollients have an occlusive effect – reduction of transepidermal water loss E.g.Soft paraffin Silicones – water resistant – used as barrier creamsE.g.Dimeticone Formulations Bath oils Creams Lotions Ointments | Patient education Review medications | GP and pharmacist to review and provide education |
| Second line therapies | Topical steroids Mild steroids Moderate steroids Potent steroids | Patient education Review medications | GP and pharmacist to review and provide education Gp to review at 6 monthly intervals or more frequently if indicated Pharmacist to review opportunistically at each dispensing. Pharmacist to refer back to prescribing clinician (or GP) as appropriate in the event of any issues arising. |
| Eradication of infection | Oral antibioticsOral acyclovirTopical antibiotics (less recommended) | Patient education Review medications | GP / SpecialistPharmacist |
| Pharmacist role in TCA | Pharmacist to be aware of underlying disease process which merits pharmacological intervention | Pharmacist to review the indications for therapy, assess the side effects of therapy and monitor compliance with therapy GP and Pharmacy to reconcile prescribing and dispensing records | Pharmacist to monitor the progress of symptoms and or complications and provide appropriate advice to patient which may include advice to return to see the prescribing clinician and or general practitioner |
| 4. Psychosocial | |||
| Depression | Identify and manage depression associated with chronic diseases including chronic dermatitis | Assessment.Medication or cognitive behaviour therapy | GP to assess and initiate managementPsychologist to provide talking therapies |
| Social isolation | Reduce social isolation | Improve social support Eg referral to support group | GP to advise and monitor |