Responding to an invitation from the All Party Parliamentary Group on Skin regarding the adequacy and equity of dermatology service provision, the BGS has made the following submission.

Older people are essential users of Dermatology services for diagnosis and treatment of skin malignancies (basal cell carcinoma, squamous cell carcinoma, melanoma, mycosis fungoides) eczema, psoriasis, skin infections and infestations, lichen planus, pressure damage, pruritis, chronic arterial and venous leg ulceration, and drug related eruptions. The prevalence of skin malignancies rises with advancing age and older people frequently fail to seek help with dermatological problems, either from feelings of embarrassment or a mistaken belief that skin disorders are a natural accompaniment to ageing.

Dermatology disorders are extremely common in the community and timely access to diagnosis, treatment and ongoing management is vital. The specialty probably requires a higher profile with greater use of multi-professional teams to enhance responsiveness and appropriateness for vulnerable people. Skin changes may be a manifestation of underlying diseases in a variety of systems so good working relationships with geriatricians, podiatrists and vascular surgeons are important.

General practitioners are very skilled in the management of Dermatology disorders but should be able to access specialist advice in a timely way. Although diagnosis and treatment are of a high standard, access to services by older people may be limited by waiting times and geographical factors if services are provided on “hub and spoke” basis. Dermatology is an ideal service to be provided locally in community settings by consultants, general practitioners with a special interest in Dermatology and nurse specialists with access to appropriate diagnostic support when needed. Clinical guidelines for common conditions are helpful in this respect. Access to Dermatological input in care homes would be helpful.

Dermatology management frequently requires complex regimes of bathing, shampooing and topical applications of creams and dressings in addition to oral medications. This necessitates appropriate community nursing support to deliver interventions for patients who may live alone with mobility problems, mental health issues and visual or dexterity problems.

Voluntary groups representing the views of older people should be consulted in the design of Dermatology services. Vulnerable patients may need guidance in order to utilise patient choice principles. There is a danger that patients with cognitive impairment could be excluded by the choice agenda.

Supporting treatments, for example radiotherapy for advanced basal cell carcinoma, often have significant waiting times and need to be timely.

There needs to be greater education and research into drug related dermatological conditions where the diagnosis may not be suspected or delayed. This is particularly important for older patients with complex drug regimes for multiple co-morbidities. Infestations amongst older people are frequently missed, indicating a need for greater awareness of common Dermatological disorders in older people.