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The 2014 National Institute for Health and Care Excellence (NICE) guidelines for the assessment and management of psoriasis were updated in 2017. There is little of note in relation to the previous articles in this series, however since the development of more biologics and cheaper forms of biosimilars, the guidelines were amended to reflect these readily available treatments (NICE, 2017a). The seventh and final article in this series provides an overview of systemic non-biological and biologic therapies. It looks at how these treatments target and treat psoriasis, as well as side-effects, contraindications and monitoring recommendations of certain drugs.
Skin tears are a common type of tissue injury, which often go unrecognised and misdiagnosed. Furthermore, classification and documentation of skin is often poor, resulting in chronic wounds with associated adverse patient outcomes. The International Skin Tear Advisory Panel (ISTAP) recently updated the International Best Practice Guidelines and definition of a skin tear based on emerging evidence and expert discussion and consensus. This article presents a discussion of the epidemiology, risk factors and causes of skin tears. In addition, the most recent best practice recommendations for the prevention, assessment, and management of skin tears is summarised.
Skin tears are a largely preventable common injury, particularly in the elderly. However, if not managed appropriately, they have the potential to develop into problematic wounds. This article discusses their classification, why they are common in ageing skin, gives advice on correct wound management strategies and how assessing the patient and their environment and simple strategies can be employed to prevent their reoccurrence.
This series has addressed the treatments for psoriasis as advised by
the National Institute for Health and Care Excellence (NICE, 2017). This condition affects between 1.3-2.2% of the population (Parisi et al, 2011). It is recognised that psoriasis can have a significant impact on mood, mental health, poor lifestyle choices (Cohen et al, 2016; Landriscina et al, 2016), reduced activities of daily living, and is linked with other comorbidities, such as diabetes (Armstrong, 2013) and cardiovascular disease (Rutter et al, 2016). NICE developed a treatment pathway, advising bland emollients, topical treatments, phototherapy, systemic medications and systemic non-biological and biologic therapy. In recent years, the latter options have increased dramatically. This article focuses on the more traditional systemic
treatments, as advised by NICE.
Skin changes due to aging are important to distinguish from those that are due to solar/sun damage. Knowledge of the common changes in the skin as it ages will help clinicians diagnose and manage any skin abnormalities identified in elderly skin while assessing other conditions. Before exploring such skin changes, however, it is important to understand how the sun affects the skin, causing changes that are observed as solar damage. This article highlights skin changes due to aging and solar damage and what actions need to be taken, if any, to manage them appropriately.
On primary infection, the varicella zoster virus is responsible for the development of chickenpox, after which the virus becomes dormant. Upon reactivation of the latent virus, shingles results. The incidence and severity of shingles increases with age, and is associated with significant morbidity and mortality. Early intervention with antiviral medications is crucial to help resolve the rash and reduce any potential complications induced by the virus.
The fourth and final article in this four-part series about understanding compression therapy explores the options available to clinicians and patients when the need for compression bandaging therapy has been established through holistic assessment. This paper presents an overview of both inelastic and elastic bandage systems. In addition, the indications for appropriate use of each of these systems and their limitations are discussed. The cost of compression bandaging to the health service budget in terms of sustainability, equipment and clinician time is also explored. Gait is a fundamental area of leg ulcer care that needs assessment as part of lower limb management. Discussion regarding the implications of compression bandaging therapy itself, as well as the presence of leg ulcers and pain on gait are provided. Finally, a review of fundamental skin care principles to protect the skin is offered.