WWL Teaching Hospitals NHS Foundation Trust

About Us

Our service focuses on patients from baby to the elderly with eczema and psoriasis, providing diagnosis, treatment and education. We aim to help and support patients/carers to become confident in self-managing these chronic skin conditions.

The Tier 2 Dermatology service has a role in the education of other primary care, secondary care and private sector professionals, supporting them to develop their dermatology expertise and service provision. The team provides education programmes to the local ST3 GP Trainees and Primary Care Dermatology study days in an attempt to improve patient care at presentation.

Dermatology Team

Dr Rachel Hilton – GP with Special Interest
Nicola Cottom – Dermatology Specialist Nurse
Helen Calderbank – Dermatology Specialist Nurse
Joanne Richardson – Dermatology Specialist Nurse

All nurses practice independently in nurse-led clinics and are registered non-medical prescribers (V300) seeing both new and follow up patients.

How can people access the service?

We accept referrals of patients diagnosed with eczema or psoriasis by a health professional (GP, Consultant, Specialist Nurse, Community Matron, Health Visitor, School Nurse, District Nurse, Walk-in Centre Nurse consultant, A&E Drs & nursing staff). Referrals can be made via choose and book or by completing the Tier Two Dermatology referral form.

Dertmatology - Community Services Referral Form

Please send referral forms to: wwl-tr.tier2derm@nhs.net

Where is the service offered?

Clinics are offered on 3 sites across the trust; Boston House, Claire House and Leigh Infirmary. The clinics are available Monday to Friday. We also provide home visits to vulnerable patients and the elderly.

Boston House, Frog Lane, Wigan, WN6 7LB

Leigh Health Centre, Leigh Infirmary, The Ave, Leigh, WN7 1HR

Claire House, Phoenix Way, Lower Ince, WN3 4NW

Who do we see?

We currently see patients with Eczema and Psoriasis only

We don’t provide second-line treatments for eczema and psoriasis patients but work closely with The Prosser White Dermatology Centre at Leigh infirmary (Dermatology – Hospital), referring patients on in need of systemic medication or ultraviolet light therapy. Children with food allergy are referred, if necessary, to Dr Castille’s team in Paediatric Outpatients at Thomas Linacre Centre, Wigan and any patients requiring patch testing for contact allergy are currently referred to the patch testing department at Salford Royal, Manchester.

Dermatology – Hospital Services

Appointment Information

Prior to Your Appointment

You must not attend your appointment if you have (or have had within the past 14 days) a fever, a persistent cough, or a change or loss in taste or smell, if you have tested positive for coronavirus, or if a member of your household has any of the above.

Please telephone the department if you have any of the above on 01942 482256

IT IS IMPORTANT THE FOLLOWING INSTRUCTIONS ARE FOLLOWED TO ENSURE THE SAFETY OF PATIENTS AND STAFF

Your Appointment

Do not arrive earlier than 5 minutes before your appointment.

You must not bring anyone with you to your appointment unless you require a carer to assist you.

The appointment letter you receive before your appointment will contain further information. Please read this carefully and if you're unsure call 01942 482256.

Please ensure you remain social distanced to our staff and other patients. You will be asked to take a seat.

You will be required to wear a surgical face mask within the department. If you do not have a surgical face mask you will be asked to change your face covering when you arrive. If there is a reason that you are unable to wear a face covering please contact us in advance.

Keeping You Safe

We are cleaning all chairs, treatment couches and equipment after each patient. Our staff will be using appropriate PPE to help keep you and them safe.

We are limiting the number of patients and staff in the department at any one time.

We are continually reviewing and assessing the situation so that we can change our practice to help keep everyone safe and well.

Frequently Asked Questions

Do I have to come to my appointment?

No. This is your choice. We are able to offer appointments via webcams and also over the telephone.

I am vulnerable or shielding should I come in?

Those who are shielding should not come in to attend an appointment. Those who are classed as vulnerable should discuss the risk versus the need for a face to face appointment with their clinician

What about a follow-up appointment?

At the end of the consultation your clinician will discuss the next step. They will confirm if this is face to face or virtual.

What will happen if I choose to have my appointment by telephone or webcam?

Telephone consultation – the clinician will ring you as close to the appointment time as possible. Please be available to take the call.

Attend Anywhere webcam – you will be sent a link to enter into your web browser, and an information leaflet, which will enable to clinician to undertake a video consultation with you at the appointment time given. Should there be any problems with this, the clinician will ring you and undertake a telephone consultation instead.

If you cannot attend clinic it will help the clinician to evaluate your skin condition if you are able to send up to 6 photographs by email. It is important that you put your/the patients name and date of birth as the subject heading. Please add the date when each photo was taken. Please note we will add your photographs to your medical record unless you instruct us not to.

Please forward photographs to the following secure email address: wwl-tr.tier2derm@nhs.net

This email address is only to be used to send us photographs. PLEASE DO NOT USE THIS EMAIL ADDRESS IF YOU WISH TO CONTACT YOUR NURSE/DOCTOR WITH A QUERY AS THE ACCOUNT IS NOT CHECKED EVERY DAY.

Changing or Cancelling an Appointment

Please contact 482256 or single point of access on 483483

Failing to Attend Your First Appointment

Any adult failing to attend their first appointment without giving notice will be discharged back to their GP unless it is indicated that another appointment is necessary.

Any child failing to attend their first appointment will automatically be offered another appointment.

Failing to attend any further appointments offered will result in discharge back to your GP.

Failing to Attend Follow-up Appointments

Any adult or child failing to attend a follow up appointment will be offered the opportunity to book another follow up appointment. A letter will be sent to you from the department with further details of how to book a further appointment.

Failing to attend further follow up appointments will result in a discharge back to your GP.

Contacting the Dermatology Unit About Prescription Queries or Problems with Your Skin

Main reception 01942 482256

How Long Will my Appointment Last?

If you are a new patient or haven't been seen by our service within the last 6 months, your appointment will last approximately 40 minutes. Any further follow up appointments will last approximately 20 minutes.

What to Bring to my Appointment?

A list of your current medication. Please bring any creams you are currently applying - a photograph of the creams will be sufficient. A list of treatments tried previously for the skin and whether they were helpful, or not.

Take lots of photos as symptoms of eczema and psoriasis can come and go so photos can be a great way of showing your health professional how your skin has been behaving.

We know that eczema and psoriasis may affect how you feel so tell your health professional how you're feeling and what impact this is having on your life as this may determine what is the most appropriate treatment.

If your treatment isn't working tell your health professional as they can move onto another which may be more successful.

If you've any questions write them down beforehand as this may help you to get the best out of your appointment.

Open Appointment System Once Discharged

You will be discharged back to your GPs care but should your skin condition become unmanageable with your current management regime, you may contact our service within a 6-month period and request a further appointment. An appointment after this time will require a new referral from your GP.

Requests for Blood Tests

Blood Test and Phlebotomy Service

Working with other services

Once a month joint sessions are held with Dr Rachel Hilton and the Lymphoedema service specialist nurses, treating those patients experiencing lower leg, skin and lymph drainage problems. We sometimes work with District Nurses, the Tissue Viability team, School Nurses and GP services but it may be necessary at times to liaise with social care, paediatric teams and dieticians; the latter referring those patients with associated food allergy.

District Nursing Service
District Nurses Treatment Room
Lymphoedema Service
Tissue Viability Service
School Nursing
Health Visiting Service
Community Dieticians

Management Plans

A management plan will be provided at the end of each appointment. If you did not receive one but would like one please speak to your healthcare professional.

Eczema and Psoriasis tends to come and go unexpectedly. People often have periods when their eczema or psoriasis calms down. Some may see clear skin or nearly clear skin during these periods. Treating your skin condition can keep it under control, helping you avoid serious flares and preventing your skin condition becoming more severe.

Keeping your eczema or psoriasis under control tends to be an on-going process. It may require appointments with our service, your GP or another heath care professional. You'll need to follow your treatment plan and learn what triggers your eczema or psoriasis. Once you know your triggers, you can try to avoid them.

While treatment may be on-going, the type of treatment you need may change. Different treatments may be necessary to, keep your skin stable, nearly clear or clear, or to control a flare-up.

At times treatment can lead to clear skin and no eczema or psoriasis symptoms. The medical term for this is "remission" A remission can last for months or years. As psoriasis and eczema can be unpredictable it is impossible to know who will have a remission and how long it will last.

Before stopping any treatments prescribed for your skin speak to your health professional as some treatments can be stopped immediately and other treatments need to be discontinued slowly to prevent your eczema or psoriasis worsening (rebound).

Covid-19 Hand Washing Advice and Information on Covid-19 for People With Eczema and Psoriasis

Professor Hywel Williams provides advice on managing the impact of dry and irritated skin resulting from frequent hand washing with soap and water to reduce Covid-19 risk in the University of Nottingham video https://mediaspace.nottingham.ac.uk/media/COVID-19+hand+washing+advice/1_wlufymil

UK GOV hand washing advice

British Association of Dermatology COVID-19 advice

Advice on COVID-19 for people with eczema

COVID-19 advice for people living with psoriasis and psoriatic arthritis

COVID-19 Skin Patterns

Eczema and Psoriasis

Eczema

National Eczema Society
National Eczema Association - Webinar Wednesday

Psoriasis

Psoriasis Association

Psoriasis and Treatments

The Psoriasis and Psoriatic Arthritis Alliance

'The Skin I'm in' video

Unavailable Treatments

Wake up to psoriasis report

Emollients

Apply emollients daily and regularly throughout the day.

Emollient Factsheet
The choice of emollients that can be prescribed locally is based on the most current specialist recommendations and cost effectiveness.

These choices are demonstrated on the Emollient Ladder below:
Emollient Ladder

Soap substitutes

Ordinary soap and bubble bath degreases the skin and damages the skin barrier, leading to drying out of the skin. You should not wash with water alone, as water is very drying. A soap substitute may be an emollient wash product or your regular leave on emollient. Simply apply it to your skin and then rinse off.

Video Guides

https://www.skinhealthinfo.org.uk/support-resources/video-guides/

Videos available on:
How to Use Topical Steroids
How to Use Emollients
Treating Scalp Psoriasis
How to Apply Wet Wraps
How to Apply Paste Bandages
How to Apply Occlusive Dressings

Finding it difficult to get emollients or emollient wash products on prescription?

https://www.eczema.org/emollients-on-prescription
https://www.psoriasis-association.org.uk/news/gp-emollient-letter

Emollients and treatments that contain paraffin - Fire risk

Paraffin-based skin emollients on dressings or clothing: fire risk

MHRA - Skin creams dried on fabric can lead to fire deaths

Topical Steroids

It may be necessary to apply topical steroids if the skin is flaring.

If potent topical steroids are prescribed in psoriasis they should be prescribed in combination with a vitamin D analogue or tar treatment in order to prevent rebound.

Topical Steroid Factsheet information can be found within the factsheet on application and fingertip units (FTU)

Mild and moderate topical steroids are available to purchase at your local pharmacy.

The choice of topical steroids that can be prescribed locally is based on the most current specialist recommendations and cost effectiveness.

These choices are demonstrated on the Steroid ladder below:
Steroid Ladder

Antihistamines

https://www.nhs.uk/conditions/antihistamines/

Antihistamines and eczema - antihistamines do not actually treat the itch, as eczema - unlike urticarial (hives) - is not caused by histamine. You may be prescribed non-sedating antihistamines if you have associated allergy or sedating antihistamines to get a better nights sleep.

Examples of antihistamines you may be prescribed following discussion with your health professional:

Cetirizine

Chlorphenamine (including Piriton)

Antibiotics

Your skin may sometimes become infected. Infection can cause the skin to change, making it look more red, itchy and swollen and may even cause it to weep and form a yellow crust. The skin may also feel hot to touch and may be more difficult to control than your usual treatments.

Infections and Eczema

Infections and Eczema leaflet

You may be prescribed a topical antibiotic (applied to the skin), or an oral antibiotic (taken by mouth) depending on the extent of the infection. For a list of the topical antibiotics which are combined with a topical steroid please see the topical steroid ladder. Topical steroid ladder.

Information on some of the more commonly prescribed antibiotics for infection in eczema and psoriasis

Erythromycin

Clarithromycin

Flucloxacillin

Other treatments you may be prescribed by your health professional

Bandages and Wet Wraps

Diluted Bleach Baths - Recipe and Instructions - A leaflet will be provided by your health professional if this is suggested as part of your management plan

Topical Calineurin Inhibitors factsheet - Protopic and Elidel

Teenagers

A guide for teenagers on eczema - Live your life

Psoteen from the Psoriasis Association

Our Leaflet

Eczema - Expert Top Tips

eMC

Electronic Medicines Compendium (eMC). The eMC is continually updated and contains information about all prescription medicines.

Schools
National Eczema Society - school pack

Eczema Outreach Support

Free support pack available

Medicines in Pregnancy

Medicines in pregnancy - your pregnancy and baby guide

Prescriptions

If you regularly pay prescription charges, a PPC could save you money.

The prescription charge in England is £9.35 per item. A PPC costs:
£30.25 for 3 months
£108.10 for 12 months

The quickest way to buy a PPC is to buy it online through the NHS BSA website.

Find a Pharmacy

Find a pharmacy

Service Achievements

We won the ALWPCT Gold award for designing and producing the topical steroid and emollient ladders and also won the Dermatology Award category at the British Journal of Nursing Awards. The ladders have recently been up-dated and follow the GMMMG formulary.

The Tier 2 Dermatology Service also won a Queen’s Nurse Institution Leadership and Innovation award in 2014 and one of the Dermatology Specialist Nurses has been awarded a Queen’s Nurse Title for her outstanding contribution to Dermatology Nursing in the Community.

Health Professionals

British Association of Dermatology
Primary Care Dermatology Society
Royal College of GPs Dermatology Toolkit
British Dermatological Nursing Group - E-Learning available
Dermatologically Tested Podcast
St John's DermAcademy Podcast
Dermatology Community - service page leaflet
Greater Manchester Joint Formulary - Chapter 13 Skin