Infective skin conditions and infestations

Healthy skin provides a tough barrier to keep out allergens and pathogens but if this barrier function breaks down or is penetrated, infections and infestations can cause disease (Gawkrodger, 2003). Skin infections and infestations are common problems and nurses need to be confident in their assessment and management. This includes not only treating the physical problem and ensuring patients and their families understand how to use the treatments correctly, in order to be effective, but also addressing practical considerations and reducing potential for recurrence if possible. This section will look at bacterial, viral and fungal skin infections and infestations. Risk factors such as age and concomitant conditions, treatment and, where possible, prevention will be considered for each subgroup.

Infections and infestations are common and many are treated by the primary care team. It is therefore important to understand the fundamentals of diagnosing these common skin conditions. Children, parents and patients who miss school or work while waiting for proper diagnosis contribute to the financial burden of these common conditions which are usually very easily treated. Infections such as impetigo and tinea are highly visible and can lead to stigmatisation and create difficulties for children at school (Popovich and McAlhany, 2007). Impetigo is also very contagious and therefore easily spread.

Early access to appropriate diagnosis and treatment can alleviate these aspects. Nurse prescribers in the community have much to contribute to the improvement of health care provision for dermatology patients (Courtenay et al., 2007), but this does mean that there is a continuing need for nurses to receive additional educational support to be ‘upskilled’ and confident in the assessment and management of such problems. There have long been calls for nurses with experience in dermatology nursing to be available in every primary care setting so that patients with skin conditions can all have access to quality dermatological care from appropriately informed nurses. An increase in the number of such nurse-clinicians would allow for greater support and advice for people with skin conditions and those that are affected. In addition and very importantly, it would lead to an improvement in the dissemination of accurate information and treatments and encourage greater adherence to therapies (APPGS, 2008). While Watson and de Bruin’s (2007) work focuses on the experiences of patients with psoriasis, it clearly demonstrates how influential the doctor/ patient relationship is to the patient’s selfconcept: the participants all agreed that they would have felt more empowered by their doctors had they empathised with their suffering, given good explanations about the disease and treatment and been alert to their related underlying emotional struggles. Such findings can be transferred across the spectrum of dermatological disease and for patients it cannot be overemphasised that a caring, empathetic nurse is therefore important for holding and addressing the patients’ physical and psychological well-being.

Skin infections (bacterial, viral and fungal) and infestations (parasites or mites which can be direct as in scabies or lice or indirect, e.g. bedbugs or fleas) cover a huge spectrum. They may range from minor conditions which neverthe- less can be embarrassing and uncomfortable to life-threatening infection where patients are systemically unwell. Dermatology is a very visual and practical field where touch is also important and nurses need an ability to recognise the changes which infection may make in the appearance and feel of skin along with an ability to accurately describe what they observe and feel. With this need to touch skin must also come education of the patient and public in infection control measures, i.e. hand washing to promote best practice in preventing transmission (Docherty, 2001).

In this section, the most commonly seen bacterial, viral and fungal infections are considered.