Factfinder
Questions to ask your doctor
Dermatology
Atopic eczema and dermatitis
A specific question for your GP: Have you had any additional training in dermatology?
Fifteen per cent of all the patients who see a GP will be seeking help for a skin condition. GPs can take additional training with the British Association of Dermatologists and other specialist organisations. Some GPs also join the Primary Care Dermatology Society which provides a forum for GPs to discuss and develop treatment of skin conditions.
Specific questions for your dermatologist:
Do you specialise in eczema?
Check our Consultant guide to see whether your dermatologist has a special interest in eczema, although all dermatologists should have a good working knowledge of the condition.
Will you do blood allergy tests?
It can occasionally be helpful to do blood allergy tests but they rarely alter your treatment. Even if you are found to have house dust mite allergens they are almost impossible to avoid and a positive blood allergy test for food allergens may not predict what happens in reality. Skin prick tests can also be done but are also limited in their value.
Are sedating anti-histamines available?
The more sedating anti-histamines, such as trimeprazine and hydroxyzine reduce itching, which is often at its worst in bed. The non-sedating anti-histamines are not very helpful unless a person also has urticaria, or nettle rash.
Contact dermatitis
Do you do patch testing for allergies?
Patch testing involves applying various test substances to the skin on adhesive patches which are then left in place for 48 hours to see if the patient has an allergy to any of the substances. The European Standard selection of allergens cause 85% of all allergic skin reactions. The dermatologist may suggest additional patch tests relating to your occupation and lifestyle. This is the only way that a doctor can identify a substance that is causing or aggravating your dermatitis.
Psoriasis
Will you provide me with a psoriasis management plan?
It's best practice for the dermatologist to give each patient a plan of management and information about treatment options. Good dermatologists should be pro-active in discussing therapies, side-effects and generally educating the patient about psoriasis.
Are vitamin D analogues available?
Three new D3 preparations, calcipotriol, calcitriol and tacalcitol have been introduced with considerable success; they are helpful, safe and cosmetically acceptable.
Are vitamin A analogues available?
Tazarotene is a new vitamin A gel that is applied once daily to patches. It may irritate the face or skin folds.
Can you provide ultraviolet treatment for psoriasis?
Sunlight can improve psoriasis although in 10% of cases sunlight can be a trigger factor. Artificial ultraviolet light is used to treat skin diseases like psoriasis and is called phototherapy. This is a standard treatment for patients with moderate to severe psoriasis who have not responded to topical therapies like ointment. It also may be used for patients whose psoriasis is extensive or disabling.
How frequently can it be supplied?
It depends on what type of phototherapy is used but the more common UVB treatment is normally two or three times a week for at least four to six weeks.
Is chemotherapy available for severe psoriasis?
This should only be used for severe cases of psoriasis that are proven to be resistant to other treatment. Powerful drugs like methotrexate or cyclosporin are taken and combined with PUVA light treatment. PUVA involves the patient taking oral or topical agents like psoralen which enhance the effectiveness of ultraviolet light on the skin. Regular blood tests should be used to monitor possible side effects of the drugs.
What are the potential side effects of phototherapy?
As with any form of sunlight, burning of the skin may occur and the dermatologist should monitor this. PUVA can have short and long-term side effects. In the short term psoralen tablets can cause sickness and the treatment can cause redness and dry, itching skin. In the long term PUVA can cause premature ageing of the skin, and an increased risk of developing certain forms of skin cancer. Statistics show that patients having more than five treatments and those with fair or freckled skin are at greatest risk. There are a range of potential side effects if a patient starts phototherapy whilst taking other medication.
Private dermatologists
Are you listed on the specialist register of the General Medical Council?
In the UK, doctors who have completed full specialist training in dermatology are listed here. A few consultant dermatologists work exclusively in the private system but the vast majority work part-time in private practice as well as working in an NHS hospital. The British Association of Dermatologists has information about almost every dermatologist practicing in the UK. http://www.bad.org.uk/about/
Can I claim your fees on my private medical insurance?
Private health insurance will not consider paying the fees unless the patient has been referred by their GP. It is important that you check your policy before seeking treatment.
Cosmetic removal of moles, blemishes and tattoos privately
Are you qualified to perform surgery?
It is crucial that a patient checks the specialist's qualifications. If they are going to perform a surgical procedure then they should have received the appropriate training and/or accreditation for cosmetic procedures ordinarily undertaken within their own speciality, which may be dermatology, plastic surgery or other surgical speciality.
How many operations have you done?
Our statistics show that the number of operations performed by a surgeon has a direct effect on outcomes. A higher volume of procedures will generally mean a higher success rate and reduced complications.
What kind of facilities do you have?
Surgery should be carried out in premises registered under the appropriate National Care Standards Commission.
What techniques do you use?
An experienced specialist will be able to recommend the most appropriate method of removal and predict the probable outcome. There are three main methods of removal which are laser treatment, surgical removal of the skin and dermabrasion (rubbing the tattoo off). The specialist should be able to point to examples of previous operations.
How high is the risk of scarring?
It depends on what is being removed, its location on the body and the patient's skin. Excision or cutting around the mole, blemish or tattoo will always leave a white scar but it depends on the surgeon's skill as to how subtle it will look. An experienced surgeon should be able to show you examples of different techniques and predict the probable outcome.
Will the surgery hurt?
Either a local or general anaesthetic can be used, depending on your circumstances. Most patients feel only mild discomfort after the surgery. Patients are usually treated in a day.
Who is the anaesthetist and what is their experience?
Doctors having operations worry as much about the anaesthetist as the surgeon. If undergoing a general anaesthetic your life is in the anaesthetist's hands even in what is otherwise a routine surgical procedure. If possible, it's good to meet the anaesthetist before the operation to check you are indeed fit for general anaesthetic.
Are there intensive care facilities?
If things go wrong with a general anaesthetic, you need good intensive care facilities. And the unexpected can happen even in apparently routine surgery, so it is important to know whether there is a facility on site or else how far away one is.