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.
This series focuses on the patient treatment pathway in managing psoriasis as laid out by the National Institute for Health and Care Excellence guidelines (NICE, 2016). This disease affects up to 1.8 million people within the UK, necessitating up to 60% of these patients requiring a form of secondary care input (Jackson, 2012). Secondary care is often required to provide further topical treatment advice, but equally this also falls within the remit of all healthcare professionals, such as community nurses, who have face-to-face contact with patients with psoriasis. As these topical treatments may not manage the symptoms of psoriasis alone, referral to dermatology departments where more specialist treatments can be prescribed may be needed. The first option is to offer a course of phototherapy. There are several forms of treatment under this umbrella, with which community nurses should be familiar.
This fourth article in a seven-part series looks at scalp psoriasis. Managing this condition can be difficult as treatments are often messy, time-consuming or ineffective. The impact of scalp psoriasis can affect several aspects of daily living, notably choice of clothes, intense itching, which can be embarrassing for patient. intense itching, which can be embarrassing for patients. Finding suitable treatments can be life-changing to some. This piece focuses on treatment options, from bland and simple techniques through to the variety of treatments available on prescription. This should enable community nurses to facilitate patients in managing their scalp psoriasis when asked
This third article in a seven-part series looking at the identification and treatment of psoriasis, explores the active ingredients and action of the main topical treatments for psoriasis. Community nurses are perfectly placed to help patients take control of their skin condition, particularly in advising them on the benefits of topical treatments, which as they can be applied directly to the skin, allow the area to be targeted, lowering the level of absorption into the bloodstream and reducing side-effects (Psoriasis and Psoriatic Arthritis Alliance (PAPAA, 2017a).
