| HEALTH NURSING IN SKIN CLINICS
1. INTRODUCTION TO NURSING PRACTICE IN SKIN CLINICS
Dermatology Nursing is the specialty of compassion and caring for patients together with scientific knowledge of dermatology illness from which patients suffer. A nurse in Social Hygiene Service Skin Clinic is entitled to called a good nurse only if he/she gets enough experience, patience, kindness and effectiveness. To be effective, nurses and doctors must work as a team which is a long and good tradition in the nursing of Social Hygiene Service.
The essential elements for nursing activities in Social Hygiene Clinics must be maintained here with emphasis on providing our clients with clear and concise explanations before and after each nursing procedure, and sound advice on the proper use of the prescribed medications.
The wrong concepts of skin diseases as being mostly contagious must be clarified. Education on the general care of ones skin can be given to our patients and the public by means of individual interviews or group talks.
Skin conditions which are generalized, weeping, acute or involving the exposed areas, especially the face, are always very traumatising psychologically and usually causes the patient to panic. This, however, can be easily overcome by the patient with the empathic, friendly and high knowledgeable attitude of the health personnel who handles him.
2. INVESTIGATIVE PROCEDURES
2.1 Venepuncture
This issue has been discussed in Section 2A of this chapter but the following points are worth mentioning :
(i) As skin diseases often co-exist with internal medical conditions, a variety of serological tests may be needed. Nurses should ensure that the correct specimen bottles and laboratory request forms are used for the tests prescribed.
(ii) The amount of blood, request form and specimen bottle required may differ from individual patients and nurses must comply with these different requests to prevent rejection of any incompatible specimen from these institutions.
2.2 Skin Patch-Test
2.2.1 Indication
To find out patient's allergen(s).
2.2.2 Application of the Test Substances
(i) Mark identification on the top of each tape to show the order of the test substances through out the testing procedure.
(ii) Remove the protective paper and place the tape on the desk with the chambers up.
(iii) Semi-solid substances are applied directly into the chamber, filling slightly more than half the chamber volume.
(iv) For liquid substance, place a filter paper disc in the chamber, moisten the disc thoroughly without surplus and place the test onto the skin within a few minutes (dry paper disc may result in weak or false negative reactions).
(v) Patient should stand or sit in a relaxed 'normal' position.
(vi) The tests are applied to healthy skin of the back, which is free of ointment and excessive sebum (if present, remove by non-irritant lotion before the application).
(vii) Apply the tap starting with the lower part and press the chamber from below upwards to let air escape.
(viii) Press each chamber gently with the finger to ensure an even distribution of the test substance.
(ix) A blue marker may be used to locate the test sites.
(x) Additional non-irritant tape may be applied to take margin for better adherence.
2.2.3 Instruction to Patients
(i) Skin Patch Test is so designed to find out the patient's allergen(s).
(ii) The patient is required to come for follow-up on the third and fifth day after the first visit for Skin Patch Test.
(iii) Rash or itchiness at a particular test site denotes he is allergic to that kind of substance.
(iv) Do not wet or remove the plastic adhesives until removal by the doctor on the third day.
(v) Avoid heavy exercise to prevent sweating.
(vi) Avoid rubbing and scratching the back.
(vii) Protect his back from direct sunlight.
(viii) Add ordinary plaster-adhesive to the original ones if it comes off accidentally. Report this to the doctor on his next visit.
(ix) Come back for follow-up if any reaction occurs on his skin within three weeks of the Test.
2.2.4 Record and Report
(i) Patient's details are written down on a "Patch Test Form".
(ii) He has to come back on the third and fifth day for reading of the test.
(iii) When the patient comes back for follow-up on the third day, the tape is removed and the Test is read after 30 minutes by the attending dermatologist.
2.3 Skin Scraping and Nail Clipping
The diagnosis of a superficial fungal infection is made by the observation of fungal element in infected keratin. This can be achieved by direct inspection of fungal element by means of light microscopy or mycology culture.
2.3.1 Explanation to Patient
(i) Explain the nature and procedures of the investigation to the patient, emphasizing that the skin will be scraped and not cut.
(ii) No pain will be encountered during the whole process.
2.3.2 Procedure
(i) Remove all local application at the scraping site (ether solvent is best).
(ii) A blunt scalpel is used for skin scraping.
(iii) Heat the scalpel before and after each specimen taking for sterilization.
(iv) Cool down the scalpel before scraping (avoid burning the patient).
(v) Specimen should be obtained from the expanding edges of a lesion as these are the sites of most active infection.
(vi) Separate scalpels should be used to obtain specimens from different sites for an individual patient.
(vii) For nail clippings, nail should be taken from any discoloured, dystrophic or brittle parts of the nail. These should be cut as far back as possible from the free edge of nail and include its full thickness.
(viii) For hair, specimen from the scalp are best obtained by scraping with a blunt scalpel. The sample should include hair stubs, the contents of plugged follicles and skin scales. Hair may also be plucked from the scalp with epilation forceps.
2.3.3 Microscopy and Reporting
(i) Scrape the skin/nail fragment onto the middle part of a glass slide, then cover up with a cover slip.
(ii) Add a few drops of 30% potassium hydroxide (KOH) to the edges of the cover slip (let KOH oozes towards the skin fragment slowly in order to prevent the cellular pattern being denatured). In case of pityriasis versicolor screening, add a few drops of Parker's stain after instillation of KOH.
(iii) Heat up the slide on top of a sterilizer till the fragment (Skin) is dissolved. Softening of the tissue can be hastened by heating gently but hairs should be handled with particular care and allowed to soften without heat so that the arrangement of spores will not be destroyed.
(iv) Inspect under light microscope. (low power 10X for screening and 40X for confirmation).
(v) Fill in patient's particulars in the microscopic book, the site of inspection and result.
(vi) When examining specimens, it is important to ensure that the material has softened adequately and that the intensity of light passing through is not too strong. It is also necessary to alter the focus while scanning the slide. Dermatophyte hyphae are regular in width, have septa and can show branching. They may be divided into arthrospores.
(vii) If hairs are infected, the size and arrangement of spores, together with the ability to fluoresce under a Wood's lamp will help towards the identification of the dermatophyte species involved. Slide may show ectothrix invasion of hair by fungi, or favus hair showing hyphae and air spaces infected by fungi.
(viii) Parker's stain (equal parts of 30% KOH & Parker's blue-black ink) is particularly useful in demonstrating the fungus (Malassezia furfur) in scales from Pityriasis Versicolor as the organism takes up this stain immediately. Thick-walled yeasts 3-8 in diameter and short angular hyphae can be revealed in the microscopic examination of infected skin scales in Parker's stain.
(ix) In nail infection (onychomycosis), thick walled, spores and scanty hyphae (spores may be in chain and Parker's stained) can be demonstrated.
(x) Cleanse the microscope (the stage and objectives) with xylene after use as KOH is corrosive.
2.3.4 Fungal Culture
(i) Put the skin fragment in the paper wrapper.
(ii) Write down patient's particulars, site of inspection etc. onto the paper wrapper. (seal up properly to avoid leakage).
(iii) Affix the specimen to the laboratory form and send to the corresponding PI.
3. MINOR OPERATIONS
Many skin conditions can be cured by means of surgical removal whereas others may need biopsy confirmation for diagnosis. Nurses have been delegated to carry out most of these minor surgeries in our service. They are trained on the job for months and are allowed to stand on their own only when the doctor or Nursing Officer in-charge is satisfied with their performance.
Clear explanation to the patients before each procedure to allay their fear and concise advice to them post-operatively to ensure genuine would healing are basic requirements in the nursing of these clients.
A large variety of minor operations are performed in our clinics but only the most commonly encountered are discussed here.
3.1 Cauterization and Curettage
3.1.1 Electrocautery
This is the employment of a small voltage/current, through a wire needle to heat an element with high resistance. It is used to burn the tissue or coagulate small vessels.
3.1.2 Curettage
This is the use of a 'curette' to remove small, well defined tumours on sites with a firm base and minimal mobile tissues.
3.1.3 Procedures
(i) Explanation, consent, positioning and sterile technique should all be observed.
(ii) Clean and anaesthetize the lesion. (Lidocaine 2%)
(iii) Identify the edges of the lesion and cauterize the upper most layer (Do not press or puncture the lesion with the desiccation needle while burning as the needle or hot temperature may damage the under-lying normal structures.)
(iv) Trim the burnt tissues with a pair of scissors and scrape off the residual burnt tissues with a curette.
(v) Repeat steps (iii) and (iv) to an appropriate depth (the base).
(vi) Trim and scrape the rim as well.
(vii) Vigorous use of the cautery may lead to undesirable damage of the underlying structures and unnecessary scarring.
(viii) For common warts, Unipolar 30 setting of the hyfrecator is recommended.
3.1.4 Advice to Patients
(i) Frequent dry dressings are required to absorb exudate. It may take 1-3 weeks for a crust to form.
(ii) Care must be taken to protect the wound trauma and wet. It probably heals in 3-6 weeks.
(iii) Bleeding may occur within the first 3 days.
(iv) The rate of healing depends on the amount of tissue destruction and the location of the lesion.
(v) The risk of infection is low, but patient should complete all the antibiotics prescribed by the doctor.
(vi) Return to the clinic if problem arises.
3.2 Management of Molluscum Contagiosum
3.2.1 Definition
It is caused by a DNA poxvirus that infects epidermal cells. Clinically the lesions appear as smooth, doom-shaped papules which are often umbilicated.
3.2.2 Incidence
It is a common childhood disease. It may spread among family members but is uncommon. (i.e. may transmit by close body contact).
3.2.3 Treatment Methods
(i) Curettage and Iodine Application
- It is done without anaesthesia.
- A curette is used to scrape off the molluscum. Ensure the central core composed of molluscum bodies is scraped off.
- Apply a tinge of iodine to the wounds with a dressed applicator for disinfection.
- Apply pressure onto the wounds for haemostasis and put on dressings if necessary.
(ii) Application of TCAA (Trichloroacetic Acid)
- Explain the procedure and nature of TCAA to the patient to gain co-operation and allay any anxiety.
- Well protect the vital organs e.g. the eyes with gauze etc.
- Apply vaseline to the surrounding healthy skin for protection.
- Apply the TCAA with a dressed applicator to the lesions.
3.2.4 Advice to Patients
(i) Healing usually takes a few days.
(ii) Keep the wounds dry for a day or two, change the dressings or band-aids if wet.
(iii) Return to the clinic if problem arises.
3.3 Management of Skin Tags
3.3.1 Definition
A skin tag is a benign freshly tumour that is acquired in adult life. It usually appears as a pedunculated flesh-coloured growth.
3.3.2 History
(i) Most patient ignore skin tags and accept their presence as a sign of aging.
(ii) It is a benign condition and will not become malignant.
(iii) Some patients request their removal because of irritation or cosmetic appearance.
3.3.3 Procedures
(i) It is done without anaesthesia except for very large skin tags where diathermy is indicated for haemostasis.
(ii) The easiest means of removal is by quickly snipping them off with scissors (i.e. excise the root of the skin tag).
(iii) The small bleeding can be arrested by low power diathermy or manual pressure.
3.3.4 Advice to Patients
(i) Healing usually takes a few days.
(ii) Keep the wounds dry for a day or two. Change the band-aids (if any) if wet.
(iii) Return to the clinic if problem arises.
3.4 Cryotherapy
3.4.1 Definition
This is a deliberate destruction of diseased tissue by cold in a controlled manner, i.e. Liquid Nitrogen (-196C).
-40C is necessary to kill normal cells by freezing alone, but
-25C is probably adequate to destroy diseased tissue
3.4.2 Rationale
(i) A rapid rate may cause more tissue damage.
(ii) A prolonged thaw may increase tissue damage.
3.4.3 Technique
(i) The cryojet is held close to the lesion. A steady spray of liquid nitrogen is directed at the centre of the lesion.
(ii) The ice-front gradually extends to the edge of the lesion.
(iii) Timing commences once solid ice is formed over the lesion.
(iv) Freezing is continued for the required period, normally no greater than 30 seconds. The spray is adjusted to maintain an iceball of a constant size.
(v) The lesion is allowed to thaw slowly.
(vi) If a second freeze is required, the lesion should be allowed to thaw completely before re-freezing.
(vii) For a malignant tumour, a 5 mm rim of normal tissue should be included around the lesion.
3.4.4 Recommended Freezing Times Lesions Approx. Freezing Time
(i) Actinic keratosis 5-10 seconds
(ii) Seborrhoeic wart 10 seconds
(iii) Viral warts : Filiform 5 seconds
Common 10 seconds
Genital 5-10 seconds
Plantar 15-30 seconds
Periungual 10-15 seconds
(beware of damaging the underlying
nail matrix)
(iv) Acquired Pigmented Naevi 20 seconds 3.4.5 Advice to Patients
(i) May encounter a burning sensation during freezing and thawing.
(ii) Analgesic e.g. Panadol/Dologesic may be taken, before spraying.
(iii) Blisters may form soon after freezing and are occasionally haemorrhagic.
(iv) A crust will usually form in 1-2 weeks and will drop off in 3-4 weeks.
(v) Dressing may be required to absorb exudate if the blisters rupture.
(vi) The treated area may initially be erythematous, but this fades leaving a hypopigmented macule.
(vii) Return to the clinic if tense blisters causing much discomfort are found after treatment.
4. PHOTOTHERAPIES
Phototherapy alone or together with ingested Psoralen (Photochemotherapy) has been proven to be effective in the management of many difficult skin disorders. Nurses' role in this issue includes the input of detail information on the treatment regime and advice on the outcome, to the patients. Supervision during the whole course of therapy and patients' compliance with the regime must also be keenly observed.
4.1 PUVA
4.1.1 Pre-treatment Preparation
(i) An instruction sheet on PUVA treatment together with verbal explanation on the nature of the therapy must be given to the patient.
(ii) Obtain written consent.
(iii) Blood screening for LFT, RFT, ANF.
(iv) Measure patient's body weight for doctor to assess the meladinine dosage.
(v) Ensure the patient has taken psoralen 2 hours before phototherapy, and to wear sunglasses after ingestion of psoralen.
(vi) Check whether the patient has erythema.
(vii) Check the correct exposure time.
4.1.2 Procedures
(i) Tell the patient to remove all clothings and cover the genitalia. The face may be shielded with a towel if it is not affected. For female patients, cover the breasts if not involved.
(ii) Ensure the patient is wearing the protective goggles.
(iii) To give accurate exposure time as prescribed.
(iv) Withhold treatment if patient complains of discomfort and inform the doctor immediately.
(v) The lower legs frequently take longer to respond to phototherapy and may need additional exposures. All other areas should be draped during the added treatment.
(vi) Remind the patient not to move about during the treatment.
4.1.3 After Treatment and Advice
(i) Remind the patient to wear sunglasses (which should be prechecked to ensure UVA opaque) for 8 hours after therapy (both indoor and outdoor), and shield from direct sunlight with sunscreens, suitable clothing, hat or umbrella.
(ii) Reassure that pigmentation that may occur will fade as exposures become less frequent after the clearing phase.
(iii) Inform the doctor if erythema or discomfort occurs.
(iv) For female patients, advise contraception. If query of pregnancy, inform the doctor immediately to stop the treatment.
(v) Check the next appointment.
(vi) Calculate the cumulative dose given.
4.1.4 Defaulters
(i) Miss one regularly scheduled treatment : dosage should not be increased, use the last dosage.
(ii) Miss more than one session : dosage should be reduced by 0.5 J/cm per session missed (Minimum : starting dose).
(iii) Defaulted for more than two sessions : see doctor again before restarting the treatment.
4.1.5 Maintenance of the Machine
(i) Check the irradiance of the machine with the UVA photometer every month. Inform the technician to change the fluorescent tubes at the recommended interval.
4.2 UVB
4.2.1 Pre-treatment Preparations
(i) Thoroughly inform the patient on the nature of the therapy. Give the instruction sheet on UVB treatment to him.
(ii) Obtain written consent.
(iii) Perform phototesting as stated by Doctor.
(iv) Check whether the patient has erythema.
(v) Check the correct exposure time.
4.2.2 Phototesting
(i) A template with holes of approximately 2 x 2 cm is affixed to the back.
(ii) Irradiate with different doses of UVB (10, 20, 30, 40 seconds). (NB deliver dose of UVB will vary with different model).
(iii) Read the result 24 hours later and determine the minimal erythemogenic dose (MED).
4.2.3 Procedures
(i) Fix the required distance (75 cm).
(ii) Select the UV switch and reflector units.
(iii) Set the required exposure time with timer switch.
(iv) Tell the patient to remove all clothings and cover the genitalia. The face may also be shielded if it is not affected. For female patients, cover the breasts if not involved.
(v) Ensure that the patient is wearing the protective goggles.
(vi) Remind the patient not to move about during treatment.
(vii) After being switched off, the burner must be allowed to cool down at least for the set period before restarted.
(viii) The field size of irradiation should be considered (e.g. if the whole body is treated, the upper and lower parts have to be treated separately).
4.2.4 After Treatment and Advice
(i) Reassure the patient that it takes 2-3 months to notice the outcome of the treatment.
(ii) Avoid direct sunlight and protect himself by sunscreen, clothing, hat and sunglasses.
(iii) Inform the doctor if erythema or discomfort occurs.
(iv) Check the next appointment.
4.2.5 Defaulters
(i) Miss one regularly scheduled treatment : dosage should not be increased, use the last dosage.
(ii) Miss more than one session : dosage should be reduced by 1/8 (12.5%) per session missed. (Minimum : starting dose).
(iii) Defaulted for more than two sessions : see doctor again before restarting the treatment.
4.2.6 Maintenance of the Machine
Inform the technician to change the bulb at the recommended interval.
4.3 Topical PUVA for Vitiligo
4.3.1 Pre-treatment Preparations
(i) Record down the patient's particulars : name, referring clinic, duration, time and the sites of treatment.
(ii) Explain on the procedure and possible complications.
(iii) Obtain written consent.
(iv) Check whether the patient has erythema.
(v) Check the correct exposure time.
(vi) Put the date, dose and nurse's signature on the referral and return the referral to the patient before he leaves.
4.3.2 Procedures
(i) Tell patient to remove all dirt, make-up, sweat or other local applications. Advice on the untoward out-come of such treatment e.g. redness, blistering.
(ii) A thin layer of maladinine paint should be applied to the leukodermic patch or bald area by means of a dressed applicator.
(iii) The paint should be applied at least 30 minutes before Ultraviolet illumination.
(iv) Warm up the machine for 5 minutes before use.
(v) Refrain form applying paint to delicate areas e.g. eyelid. Make sure no paint gets into the eyes.
(vi) Both patient and nurse should put on goggles.
(vii) Give the correct exposure.
(viii) Wash off the topical meladinine after treatment.
(ix) The treatment can be given twice weekly with an initial dose of 30 seconds at a distance of 15 cm. An increase of 10 seconds per subsequent treatment is recommended until E1 occurs.
4.3.3 Frequency of Assessment
The doctor is responsible to prescribe the starting dosage, subsequent increment and frequency of therapy for each case. He will reassess the case two weeks after commencement of treatment, then every four weeks during active phase, but, patients should be seen by the doctor if any reaction occurs.
4.3.4 Advice to Patients
(i) Inform patient of the possible response and complication e.g. redness, blistering, rash and pain.
(ii) Avoid exposure to sunlight especially on the day and the next of UV treatment. Advise on the use of sunscreens both indoor and outdoor.
4.3.5 Reactions and Defaulters
(i) If reaction is mild, maintain the dose of the last treatment. This also applies to those who has defaulted treatment once.
(ii) If defaulted for more than one session, dosage should be reduced by 10 seconds per session missed. (Minimum : starting dose).
(iii) Defaulted for more than two sessions, or if reaction is severe, e.g. severe blistering, excoriation or burning sensation, the patient should be reassessed by the doctor.
4.3.6 Maintenance of the Machine
Check the irradiance of the machine with the UV photometer every month. Inform the technician to change the bulb at the recommended interval or when the irradiance drops.
5. LASER THERAPY
Laser Safety Officer (LSO) : one of the nurses in the clinic will be appointed as LSO. His/her duty is to ensure the observation of safety on operating with a laser machine.
The information of laser therapy in our skin clinic are as follow :
Information
The VisErase is a free-standing mobile unit which uses a copper vapour laser as a convenient source of light for treating a variety of vascular and benign pigmented cutaneous lesions. The copper vapour laser emit green (511 nm) and yellow (578 nm) Lights.
Indications
(i) Recommended Laser Treatment : Yellow light
(a) Capillary cavernous haemangioma
(b) Cherry angioma
(c) Hereditary haemorrhagic telangiectasia
(d) Kaposi's sarcoma
(e) Lymphangioma
(f) Port wine haemangioma
(g) Post rhinoplasty red nose
(h) Rosacea
(i) Spider telangiectasia
(j) Telangiectasias
(ii) Recommended Laser Treatment : Green light
(a) Naevus of Ota
(b) Freckle
(c) Keratosis (Actinic/Congenital/Seborrhoeic/Solar)
(d) Lentigo
(f) Neurofibroma
(g) Naevus
(h) Viral wart
Operation of Laser Machine
(i) Manual Turn on the Laser Machine
(a) Check that the AC power lamp is lit.
(b) Turn the key switch to start (fully clockwise).
(c) Wait 5 seconds - press the HIGH button - the button should flash.
(d) After 10 minutes check that Laser Emission Lamp is lit and that no malfunction is indicated.
(e) Laser emission should begin approximately 30-35 minutes after the HIGH button has been pressed and should stabilise after 40-50 minutes.
* Safety goggles must be worn by all personnel when the laser is in use.
* Treatment should not be commenced until the Laser power has stabilised.
(ii) Preparation of Patient
(a) Go to registration counter for a disc and bring with this to the shroff office to buy a prescription sheet (MD 11177D). For government servant (GS) and dependents with the GF 181 to obtain the prescription sheet (DH 53A).
(b) Record all the particulars : name, clinic no., laser therapy no., site of treatment and especially contact telephone no. on the treatment progress sheet.
(c) Obtain consent form after explanation the procedure and after care to the patient by the MO i/c.
(d) Take Clinical photo before treatment and every follow up.
(iii) Preparation for Laser Therapy
(a) Safety goggles must be worn by all personnel when the laser is used.
(b) Protect patient's eyes with safety goggles or eye shield.
(c) Provide local anaesthesia (2% Lignocaine without adrenaline) as prescribed.
(d) Mark the treatment time.
(e) Assist the doctor in certain procedures, e.g. light adjustment, vacuum suction of excessive smoke, installation of different lens pieces.
(f) Make sure all windows are shut. The door should be locked while the laser is being used.
(iv) Manual Turn Off of Laser Machine
Turn the key switch to finish. The Laser will shut down but the cooling fan will continue to operate for about a further 15-30 minutes. The fan will automatically turn itself off at the end of this period.
(v) Aftercare Following Laser Treatment
(a) Inform patient a sunburn like reaction with possible blistering with the first 24-48 hours is expected.
(b) A crust or scab may occur after 2-3 days. Advise the patient not to remove it and let it fall off itself.
(c) Keep the area clean and dry until the scab/crust falls off. Wash gently with soap and water and apply a thin layer of antibiotic ointment.
(d) Avoid direct sunlight or sun exposure to the treated area for 3-6 months. Use at least an SPF of 15 or greater sunscreen, or wear a hat or other protective clothing (preferably both).
(e) Reassure the patient that the treatment may take up to three months to adequately judge the true response of the skin condition to the laser treatment.
(f) Check next follow-up time.
(vi) Maintenance of Laser Machine
(a) Make sure the AC power lamp is always lit. Do not turn off the main switch for Laser.
(b) Do not move the laser while it is operating or within 30 minutes of turning it off.
(c) Make sure the castor brakes are locked.
(d) Avoid liquid to enter the laser through apertures such as air vent holes. If liquid does enter, terminate use immediately, disconnect power and call for service.
(e) Do not place the fibreoptic fibre on the floor, avoid pressing across it with hard objects.
(f) Never press the utility mode when controlling the pannel.
(vii) Precautions
(a) Never look directly at the Laser bean emerging from the aperture on the main assembly or from the fibre, handpiece or scanner if one is fitted.
(b) Never operate the laser unless all personnel in the area are wearing approved laser safety goggles.
(c) If the laser light is being used near a patient's eyes, additional eye protection must be provided for the patient, i.e. using the eyeshield and anaesthetic eye drops.
(d) Never look at the laser light reflected, diffused or scattered from reflective surfaces such as glass, mirrors, metal, glossy paint, polished floors, plastic mouldings, window frames or paper.
(e) Do not use the laser in the pressure of flammable substances, e.g. ether.
6. ADVICE ON THE USE DRUGS
Topical applications have often been mistakenly regarded as less dangerous than drugs ingested and patient tends to put them on more frequently than prescribed by the doctor. This actually is extremely hazardous because many of the steroid preparations are of very high potency and may cause irreversible adverse effects if applied too often or on delicate areas such as the face. Other clients may self-treat their newly noticed skin problems with cream or ointment stocked up from previous consultations and resulting in worsening of the conditions. Therefore, nurses must educate their clients on the proper use of all drugs prescribed, with emphasis on the above misconcepts to ensure that untoward effects never occur.
Numerous types of drugs are used in dermatology treatment but only a few topical preparations which requires special attention are mentioned here.
6.1 25% Benzyl Benzoate Emulsion
(i) It is used for the treatment of Scabies.
(ii) Take a bath in the evening. Dry the body thoroughly and apply the medication thinly all over the body, sparing only the neck and head. Make sure that the application have included the hands (particularly between the fingers), the umbilical area, the groins, the area between the buttocks, and the feet (particularly the toe webs). The patient should trim the fingernails and toenails short, this allows easy assess of the medication to the undersurface of the nails. Allow the medication to dry and put on old clothings.
(iii) Next morning, repeat the application. No bath and no change of clothings required.
(iv) In the evening, take a bath to remove all the cream. Put on clean clothings.
(v) Old clothings and beddings should be treated by boiling, hot ironing or put aside for a few weeks before reuse.
(vi) The above treatment can usually kill all the mites but itching may persist for 1 to 2 weeks.
(vii) Return to the clinic if itchiness lasts for more than 2 weeks or in case of other skin eruptions.
6.2 0.5% Malathion Lotion
(i) This is the drug of choice for the treatment of infestations by lice such as Pediculosis Capitis or Pediculosis Pubis.
(ii) For treating P Capitis, the hair should be cut very short for boys. The lotion is rubbed onto the scalp at night, followed by a thorough shampoo the next morning. The same procedure may be repeated a week later.
(iii) For treatment of P Pubis, the lotion is rubbed onto the body from umbilicus to mid-thigh, front and back with special attention to the hairy parts including the anal region. Put on old clothings when the lotion is dry. This is followed by a bath the next morning so as to wash off all the lotion. Put on new clothings. The old clothings should be treated before reuse. The same procedure should be repeated a week later.
6.3 1% Potassium Permanganate Solution
(i) This is a commonly prescribed medication for skin problems and if used correctly, helps soothe a lot of conditions, especially the weeping ones.
(ii) Method of dilution :
- The stock lotion, when supplied by the pharmacy is in a 1% dilution and purplish-black in colour.
- One portion of this stock lotion is added into 79 parts of water to give a diluted solution of 1 : 8,000 concentration. (colours light pink)
- Adding 3 teaspoons of the stock lotion into a water-filled 1.25 litre COKE bottle will give the same dilution.
(iii) Soak the affected skin in the solution for approximately 10 minutes twice daily.
(iv) Never use the solution in any higher concentration or more often than prescribed.
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