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Dermatology

COVID-19

DERMATOLOGY SERVICES

During the COVID alert Dermatology will be providing limited new patient and follow up services. It is anticipated that through a mix of staff redeployment and absences, services will be modified on a weekly basis.

 

ALL APPOINTMENTS TO BE UNDERTAKEN BY TELEPHONE

All new patient appointments and follow up appointments will be provided by telephone consultation or alternative non-face to face interactions. The date and time for the appointment will be made in the normal way. Many patients need a skin examination as well as a discussion and this will require images. We have a range of solutions for this and are currently using a mix of professional medical illustration services in locations outside the hospital and asking patients to email us their images. The latter is undertaken with a dedicated exchange of messages initiated after discussion with the patient.  

 

NEW PATIENTS

Access to a new patient appointment remains through your GP. They may make a referral in the normal way or  by teledermatology which may enable you to receive an opinion sooner and avoid the need for a formal hospital consultation. 

NEW PATIENTS WITH POSSIBLE SKIN CANCER

Patients referred with possible skin cancer on the 2 week wait pathway can access it through the GP undertaking teledermatology or by normal referral. If the latter we will ask those referred  to send us images  through our dedicated email system. Most patients will be managed without a preliminary consultation and many will not need to visit the hospital for anything. Some will be requested to attend a surgical session for sampling or removal of the possible skin cancer. 

 

PATIENTS WITH RASHES OR OTHER SKIN PROBLEMS

Other patients will have access to teledermatology assistance through their GP. Some may require formal referral and they will have a telephone consultation with possible assistance of photographs in the same manner as those referred with possible skin cancer. 

All follow up appointments will be provided by telephone or similar alternative to a face to face consultation. They may require images as with the new patient consultations. This model of follow up will be for patients with rashes and skin cancer. For our patients who have had a skin cancer, you may find this video useful as a reminder on how to check your skin and lymph nodes: https://www.youtube.com/watch?v=oPtGeHBSly4 Please also see the below videos for additional support.

 

It can be useful to provide scores or use other tools to help evaluate your skin and wellbeing as part of the telephone consultation

Dermatology Life Quality Index

This tool is designed to help you measure how much your skin has affected lots of different areas of your life in the last week. We use if often for people with difficult eczema or psoriasis, but it can be used for any challenging skin disease. The link below takes you to a site where you can self score and it will provide you with a value that you can then  contribute to the telephone consultation. There is no need to enter any personal identification. The online tool is not run as part of the NHS. 

http://www.dermcalculator.com/dlqi/

PHQ-9

The PHQ-9 is a useful depression score and sometimes needed as a means of establishing your mood 

https://www.mdcalc.com/phq-9-patient-health-questionnaire-9

 

How to photograph your skin from home

 

How to check your skin

 

How to check your lymph nodes

VISITS TO THE DEPARTMENT

We aim to keep patient visits to the hospital to a minimum. There will be a small number of people who still require it. These are mainly those with the more harmful skin cancers requiring surgery and those for whom the skin disease is serious, life threatening or exceptional in some other way. 

For all visiting patients it is a risk assessment concerning the benefit of the hospital visit and the possibility of acquiring COVID-19 in connection with the visit. This will be based on the nature of the disease and the risk factors for the patient, including other illnesses, age and medications that they take which affect the immune system. The status of those they live with is also relevant. 

Some of the factors in this assessment are provided by the government: https://www.gov.uk/coronavirus

 

ADVICE TO PATIENTS ON TREATMENTS

Below is outline guidance to help you judge what forms of precaution you need to take because you are on treatment monitored by the Dermatology team. The advice for this is based on government guidelines. The links are provided and the content may change. There is some additional comment from the Dermatology team. Some people have additional health matters that may make them more vulnerable. Please keep this in mind and increase precautions if in one of the categories highlighted in the links below.

 

  Advice for dermatology patients taking the following medication during the Corona virus alert:

Azathioprine

Methotrexate

Ciclosporin

mycophenolate mofetil

fumaric acid esters

Psoriasis and Hidradenitis Suppurativa patients on biological injection therapy and apremilast

You are being sent this letter as we believe you are taking one of these medications for your skin disease.

We would recommend that you follow the advice from Public Health England on their website:

https://www.gov.uk/government/organisations/public-health-england

Because you are taking a medication to suppress the immune system, you fall into the category of vulnerable people and should follow the advice in the section on this:

https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people

For some people with higher doses of medication, more than one immune suppressing medication or additional health considerations or are older than 70, they would adopt the additional precautions of Shielding as in this guidance:

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

We would also like to remind you about advice to all our patients on immune suppression

  1. If you have a high temperature and are unwell then stop the immunosuppression and use  NHS 111 on line for further advice. You can restart once you have been well again for 2 weeks.
  2. If you have been told to self-isolate according to government rules or medical advice then stop the immunosuppression and use NHS 111 on line for further advice. You should be able to restart once you feel well again.
  3. If you have arthritis as well you should follow the advice from your rheumatologist which may be different from this.

We know that this is an anxious time for all our patients and we will do our best to support everyone to our utmost ability. However our helpline is currently understaffed and it will be difficult to respond to every call individually at this difficult time.

The Dermatology Team, Bristol Royal Infirmary

 

Consultants

Janet Angus

Specialist areas: medical and surgical dermatology


Pawel Bogucki

Specialist areas: surgical dermatology and Mohs and skin cancer, Photodynamic therapy, teledermatology


Adam Bray
Specialist areas: skin cancer, surgical dermatology and Mohs


David de Berker
Specialist areas: surgical and medical dermatology, nail diseases, teledermatology, male genital disease


Giles Dunnill
Specialist areas: medical dermatology and skin cancer, photosensitive diseases and phototherapy, blistering diseases, biologic therapy, skin lymphoma


Cameron Kennedy

Specialist areas: medical dermatology, autoimmune diseases, paediatric dermatology


Kimberlee Lim

Specialist areas: surgical dermatology and Mohs


Shalini Narayan
Specialist areas: general dermatology including skin cancer


Louise Newell

Specialist areas: paediatric dermatology and medical dermatology


Kat Nightingale (Associate Specialist)
Specialist areas: medical and surgical dermatology and skin cancer


Genevieve Osborne

Specialist areas: medical dermatology, skin cancer, paediatric dermatology, skin lymphoma


Jane Sansom
Specialist areas: eczema and contact allergy, vulval diseases, skin cancer and teledermatology


Lindsay Shaw
Specialist areas: medical dermatology and paediatric dermatology.


Debbie Shipley

Specialist areas: medical dermatology, acne, dermatology research, oral medical dermatology,  teledermatology


Aparna Sinha

Specialist areas: medical dermatology, skin cancer vulval diseases, teledermatology

 

Senior Sister

Rebecca Green

Junior Sister

Emily Chong

The University Hospitals Dermatology team also provide consultant dermatology services to North Bristol Trust.