PDP SELF-TEST QUESTIONNAIRE

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1 Number 5 CORE TUTORIALS IN DERMATOLOGY FOR PRIMARY CARE PDP SELF-TEST QUESTIONNAIRE METEOR CRATER, ARIZONA, USA LEG ULCERS Ulcer Full thickness loss of epidermis and some dermis, which will heal with scarring

CORE TUTORIALS IN DERMATOLOGY FOR PRIMARY CARE AUTHOR: DR BRIAN MALCOLM, BSc, MBChB, DRCOG, DPD, DCH, MRCGP, Dip

ASSOCIATE SPECIALIST, NORTH DEVON HEALTHCARE TRUST.

on Chapter 5 Leg Ulcers of the Core Tutorials in Dermatology for Primary Care.

Plan (PDP) folder. Having read the relevant Chapter, complete questions 1 to 12.

booklet. RESOURCES FOR MANAGING LEG ULCERS AVAILABLE FROM DERMAL.

skin. The Dermol range contain emollient oils and added antimicrobials to help protect against infection.

Adding Dermol Bath to the water, which is used to clean the ulcer, helps to soften and lift scale as well as

2 CORE TUTORIALS IN DERMATOLOGY FOR PRIMARY CARE AUTHOR: DR BRIAN MALCOLM, BSc, MBChB, DRCOG, DPD, DCH, MRCGP, Dip Derm (Glasg.). GENERAL PRACTITIONER, LITCHDON MEDICAL CENTRE, BARNSTAPLE. ASSOCIATE SPECIALIST, NORTH DEVON HEALTHCARE TRUST. PDP SELF-TEST QUESTIONNAIRE INTRODUCTION This self-test questionnaire has been written by Dr Brian Malcolm, based on Chapter 5 Leg Ulcers of the Core Tutorials in Dermatology for Primary Care. This Chapter was the fifth of a series, which was sent out to health professionals with the compliments of Dermal Laboratories. If you are no longer in possession of this chapter, you can order a replacement copy from Dermal at the address below. This self-test questionnaire has been designed so that it can be incorporated within your Personal Development Plan (PDP) folder. Having read the relevant Chapter, complete questions 1 to 12. After completing the questionnaire, you can find the information for answers 1 to 10 on the last two pages of the booklet. RESOURCES FOR MANAGING LEG ULCERS AVAILABLE FROM DERMAL. PROFESSIONAL TRIAL PACKS The skin surrounding leg ulcers is often prone to developing eczema, which benefits from the application of emollients. Dermal offer two ranges of emollients: The Doublebase trio contain emollient oils and a humectant to rehydrate dry skin. The Dermol range contain emollient oils and added antimicrobials to help protect against infection. To help with cleaning, the varicose leg is often soaked during dressing changes. Adding Dermol Bath to the water, which is used to clean the ulcer, helps to soften and lift scale as well as protecting against secondary infection. To assist with patient compliance, professional trial packs are available on request to healthcare professionals. PATIENT EDUCATION To encourage better understanding of a) dry skin and b) eczema and to explain how treatments should be applied for best results, two different pads of patient information leaflets are available for patients suffering from these conditions. To request a supply of any of the above items, please contact Dermal at the address below. SPONSORED BY DERMAL LABORATORIES, TATMORE PLACE, GOSMORE, HITCHIN, HERTS, SG4 7QR, UK. TELEPHONE: INFO@DERMAL.CO.UK DEM282/OCT08

3 QUESTIONS 1. What is the present prevalence of leg ulcers in the UK? 2. What percentage of leg ulcers are wholly arterial? 3. Is the absence of a dorsalis pedis pulse reliably indicative of arterial peripheral vascular disease? 4. What healing rates can be achieved in venous ulceration with multi-layer bandaging within 12 weeks? 5. What natural resource are alginate dressings derived from?

4 QUESTIONS 6. How high are the recurrence rates for venous ulceration in the 12 months after healing? 7. Have anabolic steroids, such as stanozolol, been shown to influence ulcer healing? 8. Give some examples of commonly prescribed drugs that can adversely influence wound healing? 9. What percentage of venous ulcers occur in the gaiter area? 10. Are routine swabs for microbiology useful in the assessment of leg ulcers?

5 REFLECTIVE LEARNING 11. What did I find useful about the learning module on Leg Ulcers? 12. Having reflected on this module, how might my practice change in managing Leg Ulcers?

6 ANSWERS (PLEASE TURN UPSIDE DOWN) QUESTION 6. Answer: Up to 70% Ref page 9 The most pessimistic data regards present recurrence rates which can be as high as 70% at one year, rising almost to 100% at five years if the deep veins are abnormal. Well fitted compression hosiery post healing and the advent of healed ulcer clinics will hopefully continue to impact on these depressing statistics. The application of open toe class II compression hosiery changed every three months in the recent Cardiff study reduced recurrence to 11%! 6 A well informed patient who has been involved at all stages in their treatment is more likely to comply with post healing regimes. QUESTION 7. Answer: No Ref page 9 There is some evidence of benefit both for the use of aspirin 7 and oxypentifylline 8 in healing chronic venous ulcers. No such benefit has been demonstrated for stanozolol. 9 Diuretics can be useful but are not a substitute for adequate compression. QUESTION 8. Answer: Non steroidal anti-inflammatories, steroids, immunosuppressants and beta blockers Ref page 3 All assessment tools should address the following: Drug history especially: Non steroidal anti-inflammatories Cortico-steroids + other immunosuppressants Beta blockers QUESTION 9. Answer: 88% Ref page 4 1). Site 88% of venous ulcers occur in the so called gaiter area. Most commonly on the medial aspect; however, extensive venous ulcers can extend to adjacent areas of the leg. If an ulcer lies exclusively outside of the gaiter area, then you must question whether it is of venous origin. Arterial ulcers commonly occur on the dorsum or plantar aspect of the foot or on the toes. QUESTION 10. Answer: No only for defined clinical indications Ref page 5 Full blood count and urinalysis would suffice with other tests as indicated from the medical history and examination. There is no place for routine swabs. These should only be taken when infection is clinically indicated, either by excessive malodour, sudden deterioration or acute onset of pain or cellulitis.

7 ANSWERS QUESTION 1. Answer: 100,000 at any one time Ref page 1 There are in excess of 100,000 active venous ulcers in the UK at any one time. QUESTION 2. Answer: 10% Ref page 2 It is important to define what we mean by a venous leg ulcer. It is an area of epidermal discontinuity lasting in excess of four weeks, occurring as a result of venous hypertension and calf muscle insufficiency. Such ulcers will comprise the majority estimated at between 70-80% of all leg ulcers, 10% will be of an arterial aetiology and 10-20% of a mixed aetiology. QUESTION 3. Answer: No it is congenitally absent in 10% and impalpable in another 10% Ref page 4 Is there evidence of arterial compromise pallor, loss of hair, nail dystrophy, coldness, poor capillary return? Are the peripheral pulses palpable? NB: The dorsalis pedis pulse is congenitally absent in 10% and impalpable in a further 10% of cases. QUESTION 4. Answer: Up to 70% Ref page 6 The gold standard was the Charing X 4 layer bandage with studies reporting 70%+ healing rates in 12 weeks. 5 The present median duration of a venous leg ulcer in the community is nine months. Recently, a study from Cardiff using a 3 layer measured tubigrip system achieved 66% healing in the same period. 6 Further outcome data from this study demonstrated 51% of venous ulcers were relatively easy to heal, but 33% particularly difficult to heal with responses correlating inversely to both the chronicity of the ulcer and its size at the onset of treatment. The application of multi-layer bandaging systems requires a significant degree of nursing expertise. QUESTION 5. Answer: Seaweed Ref page 8 4). Alginates e.g. Kaltostat: Derived from seaweed, very absorbent, hydrating and haemostatic. These can be used in moderate or heavily exuding wounds.

PDP SELF-TEST QUESTIONNAIRE LEG ULCERS. Ulcer Full thickness loss of epidermis and some dermis, which will heal with scarring.

PDP SELF-TEST QUESTIONNAIRE LEG ULCERS. Ulcer Full thickness loss of epidermis and some dermis, which will heal with scarring. Number 5 CORE TUTORIALS IN DERMATOLOGY FOR PRIMARY CARE PDP SELF-TEST QUESTIONNAIRE METEOR CRATER, ARIZONA, USA LEG ULCERS UPDATED PDP SELF-TEST QUESTIONNAIRE SEPTEMBER 2013 Ulcer Full thickness loss of