Dermatology

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Specialist services in minor surgery, dermatology and ophthalmology provided in a community setting

Cumbria Medical Services

Dermatology

Dermatology is the medical speciality which manages skin disease. This is a community based service which can deal with 99.5% of skin problems without the need to go to a major hospital setting. Management can involve treatments which range from simple advice and information to drug treatments and surgery.  If light treatment is recommended then we will arrange onward referral for you.  As GP specialists we have considerable knowledge and years of experience in dermatology. The service is also supported by consultant dermatologists and nurse specialists.

All the medical staff regularly attend dermatology courses to keep abreast of developments in this field. Cumbria Medical Services is committed to medical education and holds regular teaching sessions for local GPs and nurses to improve the breadth of dermatology knowledge in Cumbria.

 What to expect in the first appointment

NHS patients can only be seen in the community dermatology service if they have been referred by a GP.

We hope to see you promptly and generally on time but nearly always within 15-20 minutes of your appointment time.

We will ask appropriate questions to try to establish a diagnosis. It is important for us to know what medication you take and what creams you have used; so please do bring a list.

If you have a skin lesion which might need surgery please make a note of your availability as we may be able to give you a date for surgery at your appointment.

It is important for us to meet your expectations and concerns so we welcome your questions to ensure you leave the consultation satisfied.

There are often a number of treatment options and we are happy to explore these with you to provide what is most appropriate for you.

 Information on your condition

We hope to be able to give you a skin diagnosis, but this is not always possible at the first appointment as some skin conditions take time to develop. We are keen to ensure that you do understand your condition and how to manage it, even if it cannot be completely cured. We will try to explain in plain English and either give you written information or direct you to a useful dermatology website where you can find out more, if you wish.

 Follow up arrangements

We will make follow up appointments to ensure your skin condition has improved or that a skin cancer has not recurred. However, if you notice changes and feel you should be seen sooner than your set appointment, please do not hesitate to contact us and we will try to accommodate you into an earlier clinic. In many cases we are happy to review you only if you feel it is necessary. In this case we will see you at your request directly without having to go back to your GP for re-referral.

 Diagnoses

Acne vulgaris

common cause of spots from around 12 to 25. The majority of cases can be managed by your GP, but some more severe cases require treatments only available in dermatology clinics.

For more information see - www.patient.co.uk/health/acne
dermnetnz.org/acne/acne-vulgaris
www.acneacademy.org/

Actinic Keratosis

See solar keratosis

Alopecia

This is a term which describes hair loss. This can happen for many reasons. Alopecia areata is an autoimmine condition that most commonly affects the scalp. It can be very difficult to treat, but some options are available.

Info see - dermnetnz.org/hair-nails-sweat/alopecia-areata.html
www.patient.co.uk/health/Alopecia-Areata.htm

Baldness

Hair loss on the scalp is normal with age – both male and female pattern baldness are common. There is limited therapeutic threatments that can be offered on the NHS.
Also see our information under ALOPECIA

Info see - www.patient.co.uk/health/male-pattern-baldness

Basal Cell Carcinoma (BCC)

This is the commonest form of skin cancer and is related to sun exposure. This is very rarely life threatening and does not metastasise (spread to other parts of the body).  It does, however, need treating as it will continue to grow. This can be treated with creams, freezing treatment or removal surgically.

Info – dermnetnz.org/lesions/basal-cell-carcinoma

Bowen's Disease

This is a red scaly area with abnormal cells on the surface of the skin. There is a chance that this will progress to a skin cancer, about 5% do. This will be treated with either creams, cryotherapy or surgically.  It is important that people with Bowens disease use good sun protection. See sun and the skin.

Info see – dermnetnz.org/lesions/bowen.html
www.patient.co.uk/health/bowens-disease

Bullous Pemphigoid

This is a rare condition where blisters form on the skin, generally in people over 70. It normally lasts around 1-5 years then settles. Treatment is normally with oral steroids.

Info –dermnetnz.org/immune/pemphigoid

Cancer

Skin cancers come in many forms. The most common are Basal cell carcinomas (BCC), Squamous cell carcinomas (SCC) and Melanoma.

Cellulitis

This is a bacterial infection of the skin. Treated with either topical or tablet antibiotics normally.

Contact dermatitis

This is a type of eczema that occurs as a result of direct contact with causative agents. The same treatments would be used for contact dermatitis that would be used for eczema and may require patch testing to identify the cause.

Info – dermnetnz.org/dermatitis/contact-dermatitis.html
www.patient.co.uk/health/contact-dermatitis

Cysts

Pilar, epidermal, dermoid. Cysts are a harmless sac which grows deep in the skins structure. Their names relate to the structure of origin. They are sometimes removed surgically if causing problems (recurrent infections, discomfort etc).

Info - dermnetnz.org/lesions/cysts.html

Dermatitis herpetiformis

This is a very itchy bump, normally on the scalp, shoulders, elbows knees and buttocks.  This is strongly associated with coeliac disease (gluten intolerance).

Info - dermnetnz.org/immune/dermatitis-herpetiformis.html

Dermatofibroma

This is firm skin nodules which are harmless. They normally appear on legs or arms, possibly at the sites of trauma (eg an insect bite).

Eczema or Dermatitis

Inflammation of the skin results in an itchy, dry skin rash. It is common in children but can last into adulthood. It is caused by a combination of genetic predisposing factors and environmental irritants.
Children often ‘grow out ‘ of eczema, but for others it is a condition that needs long term treatments to try and prevent flare-ups.

Info - http://www.eczema.org
dermnetnz.org/dermatitis/dermatitis.html

Erythema Nodosum

Tender red nodules, typically on the lower legs but also occasionally on thighs or arms. Often no cause is found, but some investigations are usually performed to check if treatment is required. 

Info - dermnetnz.org/vascular/erythema-nodosum.html

Folliculitis

Inflammation of a hair follicle. This is most commonly, but not always, due to infection. It can be due to irritation or blockage.

Fungal nail infections

These are common and most will be dealt with by your GP. Occasionally diagnosis can be difficult and stubborn infections can require long courses of treatment (up to a year).

Info - dermnetnz.org/fungal/onychomycosis.html
www.patient.co.uk/health/fungal-nail-infections-leaflet

Granuloma Annulare

A condition where skin coloured bumps forma ring, typically over a joint, the cause for which is unknown. Other rarer forms produce nodules or larger patches of little bumps.
The condition tends to settle after a few months without scarring, but can recur at the same site.

Hidradenitis suppurativa

A condition with recurrent boils and abscesses most commonly in armpits and the groin. There are lots of different treatment options, including topical options, tablets and surgical removal of the affected skin.

Info - www.dermnetnz.org/acne/hidradenitis-suppurativa.html
www.patient.co.uk/health/Hidradenitis-Suppurativa.htm
www.hstrust.org

Hyperhydrosis (excessive sweating)

This can be a very distressing problem, affecting palms, soles and /or underarms typically. Topical treatments can be tried, but all have problems.

Info - dermnetnz.org/hair-nails-sweat/hyperhidrosis.html
www.hyperhidrosisuk.org/

Itch

Also known as prurigo. This can be due to many factors. Once medical causes have been excluded topical treatments can normally resolve this very distressing symptom. Occasionally phototherapy (light therapy) is needed.

Info - www.dermnetnz.org/systemic/itch.html

Keloid scar

Occasionally scars can become overgrown and form hard, smooth growths. It is unknown why this happens. It is most common in the upper chest, shoulders and upper back. Dark skin is more prone to form keloids. There are some topical options that can help with cosmetic appearance. These never become cancerous.

Info - www.dermnetnz.org/dermal-infiltrative/keloids.html

Lichen Planus

A rare skin condition that results in shiny, flat topped areas of the skin that are red or purple coloured. They tend to be very itchy. It often resolves in around 18 months and topical treatments can be used to try and control it whilst it is active. It can also affect the nails, genitalia and inside your mouth.

Info - www.dermnetnz.org/scaly/lichen-planus.html
www.uklp.org.uk/

Lichen Simplex

A type of dermatitis with a patch of dry, scaly itchy skin. It usually occurs due to repeated rubbing or scratching at a site following an original itchy stimulus – for example a bite. It can normally be controlled with strong topical steroids, moisturisers and lots of will power from the patient to stop the scratching.

Info - www.dermnetnz.org/dermatitis/lichen-simplex.html

Lichen Sclerosis

This condition most commonly affects the genitalia and affects women more frequently than men. It can be controlled well with topical treatments in most cases, but not cured. The skin becomes white and thickened and easily cracked. It can be very itchy.

Info - dermnetnz.org/immune/lichen-sclerosus.html

Melasma or chloasma

Patches of increased pigmentation to darker skin colour, on the cheeks. This becomes more obvious with sun exposure, so patients are recommended to avoid the sun. It can appear in pregnancy or whilst taking the oral contraceptive pill and may not disappear when it is stopped.

Info - www.dermnetnz.org/colour/melasma.html

Molluscum contagiosum

A viral skin infection resulting in clusters of small round bumps, often on a stalk (pedunculated). They are most common in children but can appear in adults. They tend to disappear in about a year, but can persist longer, especially in children with eczema. No treatment is required.

Info - www.dermnetnz.org/viral/molluscum-contagiosum.html

Nodular prurigo

A disorder with firm, very itchy lumps in the skin. It is unknown if the itch and scratching cause the lumps or if the lumps are first. There are lots of different topical and oral treatments that can be tried and phototherapy can also be helpful.

Info - www.dermnetnz.org/dermatitis/prurigo-nodularis.html

Pemphigus vulgaris

A rare blistering disorder that typically occurs in people in their 50’s and 60’s. It affects both the skin and membranes of the mouth and genitalia. It is normally controlled with oral medications.

Info – www.dermnetnz.org/immune/pemphigus-vulgaris.html
www.pemphigus.org.uk/

Perioral dermatitis

This is a relatively common skin problem seen mainly in adult women. It presents as redness and itchy red bumps around the mouth, and occasionally around the eyes (periorificial dermatitis). The skin often flakes. It can be induced by the use of too many creams, and sometimes using just water to clean the skin is enough to settle it down. It will respond well to oral antibiotics should this not be enough.

Info - http://www.dermnetnz.org/acne/perioral-dermatitis.html

Pityriasis rosea

A common widespread scaly rash that starts with a ‘herald patch’. It is thought to follow a viral infection, and normally resolves in about 6 weeks. It can occasionally itch, and this can be treated with a topical steroid cream.

Pityriasis versicolor

A common skin complaint with flaky discoloured areas of skin typically on the chest and back. It is linked to a yeast infection, Malassezia. It normally responds well to topical treatment with antifungal creams or shampoo. Occasionally antifungal tablets are needed.

Polymorphic light eruption

This is a rash that occurs due to photosensitivity – sensitivity to the sun. It can take many forms (hence its name polymorphic), but most commonly it presents as pink or red raised spots on sun exposed sites. It often appears in Spring and may disappear as sun exposure becomes more frequent in the summer. Juvenile spring eruption is a form often seen in young boys where it is present only on the ears.

Info - www.dermnetnz.org/reactions/pmle.html

Pompholyx

A type of eczema that affects the hands and/or feet. The majority of cases can easily be managed with topical treatments, but some cases will require specialist oral treatments, and sometimes light therapy is used.

Info – www.dermnetnz.org/dermatitis/pompholyx.html
www.patient.co.uk/health/pompholyx
www.pompholyx.co.uk/

Psoriasis

This is a common scaly rash that affects at least 2% of the population. There is a spectrum of disease severity and psoriasis has several different forms. Treatments are wide ranging and vary for severity and form of psoriasis. There is no cure, but the condition can be well controlled.

Info - www.patient.co.uk/health/psoriasis
http://www.dermnetnz.org/scaly/psoriasis-general.html
www.papaa.org
www.psoriasis-association.org.uk

Pyogenic granuloma

This is a bright red skin growth that is fast growing and is said to have the appearance of a raspberry or raw meat. They are not cancerous but can bleed profusely. They need removing for this reason and also to confirm the diagnoses as they can resemble some skin cancers.

Info - www.dermnetnz.org/vascular/pyogenic-granuloma.html

Rosacea

A facial skin rash that tends to affect people in middle age. It often has small spots in the skin, but the key feature is the redness. Skin thickening can also be a problem. Topical or oral antibiotics can be used and offer a lot of patients good control for any spots. The redness is more difficult to treat – often avoidance of factors that cause flushing can be helpful. Laser is also sometimes used.

Info - www.dermnetnz.org/acne/rosacea.html
www.patient.co.uk/health/Rosacea.htm

Sebaceous hyperplasia

A term used for enlarged sebaceous glands normally on the nose and forehead. These can sometimes look like a BCC and therefore are sometimes removed for diagnostic reasons.

Info - www.dermnetnz.org/acne/sebaceous-hyperplasia.html

Seborrhoeic dermatitis

A scaly rash that affects the scalp, eyebrows, side of the nose, around and in the ears. It can also affect the central chest area and under the arms. It is thought to be due to an inflammatory response to the presence of a yeast, Malassezia.  It is a chronic condition, but can usually be controlled with regular use of topical antifungals and occasional topical steroid use.

Info - www.dermnetnz.org/dermatitis/seborrhoeic-dermatitis.html

Seborrhoeic warts

Also known as seborrhoeic keratoses. These are harmless growths that appear in adult life. They never become cancerous, but do change with time. You may have one or many. They can be removed if they catch on clothes are becoming inflamed regularly.

Info www.dermnetnz.org/lesions/seborrhoeic-keratosis.html

Solar Keratoses

Also known as actinic keratoses. These are areas of rough skin on sun exposed areas. They are caused by long term sun exposure. They are a precancerous condition with a low risk of turning to a squamous cell cancer.  For this reason they are often treated. They can be treated with creams, freezing therapy or removed surgically.
Patients should also take sun precaution at all times once they have had once solar keratosis.

Info - www.dermnetnz.org/lesions/solar-keratoses.html

Urticaria

A disorder that can affect adults or children where itchy, red patches or ‘hives’ appear on the skin. This can be acute or chronic.

Info see - dermnetnz.org/reactions/urticaria.html
- www.patient.co.uk/health/acute-urticaria-hives

Vitilgo

A disorder where the skins pigment cells that colour the skin are destroyed leaving patches of the skin with no colour.
Vitiligo unfortunately does not respond well to treatment.
It is important to protect the skin from sun exposure as the pale skin has no protection in the form of melanocytes.

Info - www.dermnetnz.org/colour/vitiligo.html
www.vitiligosociety.org.uk/

Warts and veruccas

These are skin growths due to infection with HPV (human papilomma virus). 50% of warts and veruccas disappear with 6 months, and 90% within 2 years. Treatments are not terribly successful, but paints, freezing and duct tape can be used. These can be time consuming and painful, and so most warts are best left to go by themselves.

Info - www.patient.co.uk/health/warts-and-verrucas
www.dermnetnz.org/viral/viral-warts.html

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