Dermatology Nursing Guide

Primary Lesion Morphology

Lesion	Definition	Examples
Macule	Flat, non-palpable colour change <1 cm	Freckle, early vitiligo, petechiae
Papule	Raised, solid lesion <1 cm	Acne, molluscum, lichen planus
Plaque	Raised, flat-topped lesion >1 cm	Psoriasis, mycosis fungoides
Vesicle	Fluid-filled blister <1 cm	HSV, varicella, dyshidrosis
Bulla	Fluid-filled blister >1 cm	Bullous pemphigoid, TEN, burns
Pustule	Pus-filled lesion	Acne, folliculitis, impetigo
Nodule	Deep, solid, raised >1 cm	Lipoma, cyst, melanoma
Wheal	Transient, oedematous papule/plaque (urticaria)	Urticaria, dermographism

Secondary Lesions

Surface Changes

Scale: dried flakes of stratum corneum (psoriasis, tinea)
Crust: dried serum/pus/blood (impetigo — golden crust)
Lichenification: thickened skin with accentuated skin markings (chronic eczema)
Excoriation: scratch marks — linear erosions

Depth Changes

Erosion: partial-thickness skin loss (stays moist, heals without scar)
Ulcer: full-thickness skin loss into dermis/subcutis
Fissure: linear crack through epidermis (hand eczema, athlete's foot)
Scar: fibrous replacement of dermis — hypertrophic vs. keloid

SCAM Assessment Framework

Size
Measure in mm — longest diameter, depth

Colour
Uniform vs variegated; erythema, hypo/hyper-pigmentation

Appearance
Surface texture, border regularity, satellite lesions

Morphology
Primary + secondary lesion types, configuration

Distribution Patterns

Photodistributed — sun-exposed: face, V-neck, dorsal hands (lupus, polymorphic light eruption)
Flexural — antecubital, popliteal fossa (atopic eczema)
Extensor — elbows, knees (psoriasis)
Dermatomal — unilateral, follows dermatome (herpes zoster)
Intertriginous — skin folds: axilla, groin, submammary (tinea, candida)

Fitzpatrick Skin Type Scale — GCC Relevance

Type I
Always burns, never tans
Rare in GCC

Type II
Usually burns, sometimes tans
Uncommon

Type III
Sometimes burns, always tans
Common GCC

Type IV
Rarely burns, always tans
Predominant

Type V
Very rarely burns, deeply tans
Common GCC

Type VI
Never burns, deeply pigmented
Common GCC

GCC Clinical Pearl: Types III-VI predominate. Erythema (redness) is LESS visible in darker skin types — rashes may appear violaceous or hyperpigmented rather than red. Burns and serious reactions can be missed. Post-inflammatory hyperpigmentation is more pronounced and distressing. Assess for warmth, oedema, and texture changes rather than relying on colour alone.

Dermatoscopy (Dermoscopy) Basics

Purpose

10x magnification of skin structures
Reduces unnecessary biopsies by ~50%
Differentiates benign vs malignant pigmented lesions
Used in combination with ABCDE criteria

Key Patterns

Pigment network: regular = benign; irregular/atypical = concern
Regression structures: white scar-like areas — melanoma risk
Vascular patterns: dotted vessels (melanoma), arborising (BCC)

Two-step algorithm:
Step 1: Is it melanocytic?
Step 2: If melanocytic — is it benign or malignant?

Nursing role: Document findings, photograph for monitoring, refer to dermatologist if any concern

Skin Lesion Descriptive Assessment Tool

Primary Lesion Type

Size (mm)

Colour

Border

Surface

Distribution

Clinical Description (for documentation)

Differential Diagnoses

Recommended Assessment Actions

Eczema / Atopic Dermatitis

SCORAD Scoring

Component	Max Score
Extent (rule of nines %BSA)	20
Intensity (6 signs × 0–3)	18
Subjective (itch + sleep loss)	20
Total max: 103 — <25 mild \| 25–50 moderate \| >50 severe

GCC Exacerbation Triggers

Heat and excessive sweating (summer temperatures >45°C)
Sand and dust exposure (desert environment)
Air conditioning — low humidity, dry air
Chlorinated water (swimming pools)
Synthetic fabrics / abaya/thobe materials

Treatment Ladder

Emollients: first-line always — apply within 3 min of bathing
Topical corticosteroids (TCS): see potency ladder below
Topical calcineurin inhibitors: tacrolimus 0.1%/0.03%, pimecrolimus 1% — steroid-sparing, safe on face/skin folds
Wet wrap therapy: diluted TCS under wet then dry bandage — severe acute flares
Dupilumab (Dupixent): IL-4/IL-13 inhibitor — moderate-severe refractory, ≥12yrs. Injection site reactions, conjunctivitis risk
Systemic immunosuppressants: ciclosporin, methotrexate, azathioprine

Topical Corticosteroid Potency Ladder & Finger-Tip Unit Guide▶

Potency	Examples	Use Area
Mild (Class 1)	Hydrocortisone 0.5–2.5%	Face, groin, axilla, infants — daily use safe
Moderate (Class 2)	Clobetasone butyrate 0.05%, Betamethasone valerate 0.025%	Body, limbs — short courses
Potent (Class 3)	Betamethasone valerate 0.1%, Mometasone 0.1%	Thick skin areas, scalp — avoid face
Very Potent (Class 4)	Clobetasol propionate 0.05%	Palms, soles, lichenified lesions — max 2/52

Finger-Tip Unit (FTU)

1 FTU = amount squeezed from index finger tip to first crease = ~0.5g
Face & neck: 2.5 FTU | Chest or back: 7 FTU each
One arm: 3 FTU | One hand (both sides): 1 FTU
One leg: 6 FTU | One foot: 2 FTU
Apply thin layer — skin should NOT look shiny/wet after application

Side effects: skin atrophy, striae, telangiectasia, adrenal suppression (extensive use), purpura. Children and face/folds most vulnerable.

Psoriasis

PASI Score

Body divided into: head, upper limbs, trunk, lower limbs
Each area: erythema + induration + scaling (0–4 each)
Weighted by BSA involvement
Max 72 — PASI <10 mild | 10–20 moderate | >20 severe
PASI 75 = 75% improvement = treatment success target

Special Sites

Nail psoriasis: pitting, onycholysis, oil-drop sign, subungual hyperkeratosis — affects up to 50%
Scalp psoriasis: thick silvery plaques — use coal tar shampoo, clobetasol solution
Psoriatic arthritis: seronegative — affects up to 30%

Treatment Pathway

Topical: vitamin D analogues (calcipotriol), TCS, combination (Dovobet)
Phototherapy: PUVA (psoralen + UVA) or NB-UVB — max 200 sessions lifetime
Systemic conventional: methotrexate, ciclosporin, acitretin
Biologics:

Class	Examples
TNF-α inhibitors	Adalimumab, etanercept, infliximab
IL-17 inhibitors	Secukinumab, ixekizumab — rapid clearance
IL-23 inhibitors	Guselkumab, risankizumab — durable remission
IL-12/23	Ustekinumab — 12-weekly dosing

Contact Dermatitis

Types

Irritant (ICD) ~80%: direct toxic damage — no sensitisation needed. Cumulative hand irritation from detergents, frequent hand washing (HCWs in GCC)
Allergic (ACD) ~20%: Type IV delayed hypersensitivity — requires prior sensitisation. Patch testing essential for diagnosis

Patch Testing

Finn chambers applied to upper back
Read at 48h and 96h
Results: negative / irritant / 1+ to 3+ allergic reactions
Standard European baseline series of 30 allergens

GCC Occupational Context

Construction workers (largest GCC workforce): cement/chromate — chromate allergy, epoxy resins, cutting oils, rubber accelerators in gloves. Key allergens: potassium dichromate, thiurams, carba mix, nickel, formaldehyde resins.

Common GCC Allergens

Black henna (PPD — paraphenylenediamine)
Bakhoor/oud perfume ingredients
Gold/nickel (jewellery)
Nail cosmetics (acrylates)
Latex gloves (healthcare workers)

Bacterial Skin Infections

Impetigo

Non-bullous (70%): Staph. aureus / Strep. pyogenes — golden crusted erosions around nose/mouth
Bullous: Staph. aureus toxin — flaccid bullae on trunk
Rx: mupirocin 2% topical (limited) | oral flucloxacillin or cefalexin 500mg QDS 7 days
Highly contagious — school/work exclusion until crusts resolved

Erysipelas

Superficial dermis — Group A Strep, sharply demarcated raised border
Usually face or leg — bright red, warm, oedematous, systemic upset
Rx: benzylpenicillin IV or amoxicillin PO

Cellulitis

Deeper dermis/subcutaneous — less sharp border than erysipelas
LRINEC score (Laboratory Risk Indicator for Necrotising Fasciitis): CRP, WCC, haemoglobin, sodium, creatinine, glucose — score <6 low risk | 6–7 intermediate | >8 high risk NF
Mark border with surgical pen — reassess 1-2 hourly to monitor spread
IV flucloxacillin if systemically unwell; co-amoxiclav for polymicrobial risk (diabetics, bites)

MRSA Skin Infections

Suspect if failure of standard antibiotics
Community MRSA: painful boils/abscesses — incision & drainage + doxycycline/trimethoprim
Hospital MRSA: vancomycin IV or linezolid; contact isolation

Necrotising Fasciitis — LRINEC Scoring & Surgical Emergency Pathway▶

Parameter	Value	Points
CRP (mg/L)	≥150	4
WCC (×10⁹/L)	15–25 / >25	1 / 2
Haemoglobin (g/dL)	11–13.5 / <11	1 / 2
Sodium (mmol/L)	<135	2
Creatinine (μmol/L)	>141	2
Glucose (mmol/L)	>10	1

LRINEC ≥6 = HIGH SUSPICION — SURGICAL EMERGENCY
Finger Test: Under LA, 2cm incision over suspicious area. Absence of bleeding, grey necrotic tissue, no resistance to finger dissection = POSITIVE → immediate theatre for surgical debridement.

Emergency pathway: 1) Call surgeon immediately 2) Broad-spectrum IV antibiotics: piperacillin-tazobactam + clindamycin + vancomycin 3) IV fluids/resus 4) ICU 5) Theatre within 6 hours — mortality increases 9% per hour of delay 6) Hyperbaric oxygen adjunct where available

Fungal Infections

Condition	Organism	Presentation	Treatment
Tinea pedis (athlete's foot)	Trichophyton rubrum	Interdigital maceration, scaling, pruritus	Clotrimazole 1% cream 4/52 or terbinafine 1% cream 1/52
Tinea corporis (ringworm)	T. rubrum, T. tonsurans	Annular scaly plaque with central clearing	Topical terbinafine/clotrimazole; oral for extensive
Tinea capitis	T. tonsurans, Microsporum	Scaly scalp patches, broken hairs, lymphadenopathy	Oral griseofulvin or terbinafine 4–8 weeks
Onychomycosis	Dermatophytes/Candida	Thickened, discoloured, brittle nails	Oral terbinafine: 250mg daily — 6wks fingernails, 12wks toenails. Monitor LFTs. Amorolfine lacquer adjunct
Pityriasis versicolor	Malassezia furfur	Hypo/hyper-pigmented patches on trunk — GCC: very common in heat/sweat	Ketoconazole 2% shampoo applied 5 min daily ×5 days; selenium sulfide. Recurrence common

Viral Skin Infections

Herpes Zoster (Shingles)

Reactivation of VZV from dorsal root ganglia
Prodrome: burning/tingling/pain in dermatomal distribution 1–4 days before rash
Vesicular rash in single dermatome — never crosses midline
Treatment: aciclovir 800mg 5× daily × 7 days — MUST START WITHIN 72h of rash onset for maximum benefit
Analgesia: paracetamol/ibuprofen, consider amitriptyline/gabapentin early to prevent PHN
Ophthalmic zoster (V1) → same-day ophthalmology review
Post-herpetic neuralgia (PHN): pain persisting >3 months — older patients, severe acute pain = risk factors

Herpes Simplex Virus (HSV)

HSV-1: oro-labial / HSV-2: genital (overlap increasingly common)
Primary episode: painful grouped vesicles/ulcers, systemic upset
Recurrent: prodromal tingling, milder episode
Rx: aciclovir 200mg 5× daily × 5 days (primary); topical aciclovir for labial HSV
Suppressive therapy for ≥6 recurrences/year: aciclovir 400mg BD

Molluscum Contagiosum

Poxvirus — umbilicated pearly papules
Mostly self-limiting in immunocompetent — 6–18 months
Extensive disease — consider HIV screen in adults

Infestations

Scabies — GCC Healthcare Settings Treatment Protocol▶

GCC Context: Scabies outbreaks common in shared accommodation — migrant workers in construction/domestic sectors. Highly contagious — entire household/close contacts MUST be treated simultaneously even if asymptomatic.

First-Line Treatment

Permethrin 5% cream: Apply from neck to toes (including under nails, between fingers, genitalia). Leave 8–12 hours. Wash off. Repeat after 7 days.
For head/neck in elderly, immunocompromised, infants: apply to face also
Nails: trim short, apply cream under nails with soft brush

Second-Line / Crusted Scabies

Oral ivermectin 200 mcg/kg — 2 doses 1–2 weeks apart. Not in pregnancy/infants <15kg.
Crusted (Norwegian) scabies: combination permethrin + ivermectin + keratolytics. Contact isolation essential.

Environmental Decontamination

Wash all clothing, bed linen, towels at 60°C or higher
Items that cannot be washed: seal in plastic bags for 72 hours (mites die without human host)
Treat all household/dormitory contacts on SAME DAY
Pruritus may persist 2–6 weeks after successful treatment — reassure, antihistamines for itch

Healthcare Setting Protocol

Contact precautions: gloves + gown — until 24h after first treatment
Notify occupational health — screen and treat exposed HCWs
Document outbreak — report to infection control team per DHA/DOH policy

Head Lice (Pediculosis Capitis)

Diagnosis: visualise live louse or nit within 1cm of scalp
Rx: dimeticone 4% lotion × 2 applications 7 days apart — no resistance issue (physical action)
Alternative: malathion 0.5% or wet combing (detection combing) if chemical aversion
Treat all household members simultaneously; fine-tooth combing — wet hair + conditioner

Stevens-Johnson Syndrome (SJS) & Toxic Epidermal Necrolysis (TEN)

DRUG REACTION EMERGENCY — Stop causative drug IMMEDIATELY
Common culprits: allopurinol (most common GCC — gout treatment), carbamazepine, lamotrigine, sulfonamides (co-trimoxazole), NSAIDs, nevirapine

Classification by % BSA Detachment

SJS: <10% BSA — still serious
Overlap: 10–30% BSA
TEN: >30% BSA — mortality up to 50%

SCORTEN Mortality Score

Calculated at day 1. 1 point each: age >40, malignancy, HR >120, initial BSA >10%, serum urea >10, glucose >14, bicarbonate <20

Score	Predicted Mortality
0–1	3.2%
2	12.1%
3	35.3%
4	58.3%
≥5	>90%

Management

Stop ALL suspected drugs immediately
ICU or burns unit admission
Ophthalmology review — ocular involvement leads to blindness
Strict fluid balance — treat like burns (IV fluid resuscitation)
Nutritional support (NG feeding) — protein loss from skin
Temperature regulation — warm environment (skin barrier lost)
Wound care — non-adhesive dressings; avoid skin stripping
Oral care — mucosal involvement — chlorhexidine mouthwash, lip care
Genital care — urethral/vaginal mucosal involvement

Pharmacological controversy: Corticosteroids — evidence mixed; most experts avoid in TEN. IV immunoglobulin (IVIG) and cyclosporin used in specialist centres — limited evidence but widely used in GCC.

Erythroderma

Definition: Erythema covering >90% BSA. Dermatological emergency — significant morbidity from thermoregulatory failure, protein loss, high-output cardiac failure.

Causes (mnemonic: PSALM-D)

Psoriasis (most common) — 25%
Skin conditions — eczema, seborrhoeic
Allergic/drug reactions
Lymphoma / cutaneous T-cell (Sézary syndrome)
Miscellaneous — rare dermatoses
De novo (no identifiable cause) — ~25%

Nursing Management

4-hourly vital signs — HR, BP, temperature, oxygen saturation
Temperature regulation: warm environment (skin barrier impaired — hypothermia risk)
Daily weights — fluid balance assessment
Regular emollient application — white soft paraffin or aqueous cream bath
Monitor albumin, electrolytes — protein exudate from skin surface
High-protein high-calorie diet or dietitian review
Daily skin assessment — blistering, secondary infection signs

Autoimmune Blistering Disorders

Pemphigus Vulgaris

IgG autoantibody against desmoglein 3 (and 1) — intra-epidermal split
Flaccid blisters — rupture easily leaving painful erosions
Oral mucosa ALWAYS involved (may precede skin by months)
Nikolsky's sign POSITIVE: lateral pressure on normal skin causes skin to slide/blister
Rx: high-dose prednisolone + azathioprine/mycophenolate; rituximab for refractory cases
Monitor: blood glucose (steroid-induced DM), BP, osteoporosis prophylaxis

Bullous Pemphigoid

IgG autoantibody against BP180/BP230 — sub-epidermal split
Tense blisters on erythematous/urticarial base — elderly patients (>70 years)
Oral involvement less common than PV
Nikolsky's sign NEGATIVE (tense bullae, sub-epidermal)
Pruritus often severe before blisters appear
Rx: potent topical clobetasol, oral prednisolone, doxycycline + nicotinamide; azathioprine steroid-sparing

Melanoma — ABCDE Criteria & Management

ABCDE Criteria

Letter	Feature	Concern
A — Asymmetry	Shape	Irregular, asymmetrical
B — Border	Edge	Irregular, notched, blurred
C — Colour	Pigmentation	Variegated — brown, black, red, white
D — Diameter	Size	>6mm (pencil eraser) — but early can be smaller
E — Evolution	Change	Growing, changing, new ulceration/bleeding

Staging & Prognosis

Breslow thickness: depth of invasion in mm — single most important prognostic factor
<1mm = excellent prognosis | 1–4mm = intermediate | >4mm = poor
Clark level: anatomical depth (I–V)
Sentinel lymph node biopsy (SLNB): for Breslow >1mm or <1mm with high-risk features (ulceration, mitoses)

GCC Note: Melanoma may be amelanotic (non-pigmented) — particularly on palms/soles/nail beds (acral lentiginous type) — more common in darker skin types but STILL occurs. High index of suspicion for non-healing lesions on acral surfaces.

Pressure Injury Staging — NPIAP Classification

Stage	Description	Key Features
Stage I	Non-blanchable erythema of intact skin	Skin intact; redness does NOT blanch with 30s pressure; may be darker discolouration in dark skin types
Stage II	Partial thickness skin loss	Open shallow wound with red/pink wound bed OR intact/ruptured serum-filled blister. No slough/eschar.
Stage III	Full thickness skin loss	Subcutaneous fat visible; slough/eschar may be present; no exposed bone/tendon/muscle. Tunnelling possible.
Stage IV	Full thickness tissue loss	Exposed bone, tendon, or muscle; slough/eschar; often tunnelling and undermining.
Unstageable	Depth unknown — covered by slough/eschar	Cannot stage until base visible. Stable dry eschar on heels = do NOT remove (natural protection)
Deep Tissue	Persistent non-blanchable deep red/maroon/purple discolouration	Intact or non-intact skin; pressure/shear injury to soft tissue. May rapidly deteriorate to Stage III/IV.

Braden Scale Risk Assessment

Subscale	Score Range
Sensory perception	1–4
Moisture	1–4
Activity	1–4
Mobility	1–4
Nutrition	1–4
Friction & shear	1–3
Total	6–23

Risk Categories

19–23: No risk
15–18: Mild risk
13–14: Moderate risk
10–12: High risk
≤9: Very high risk

Reassess: on admission, after surgery, change in condition — at least 48-hourly in acute settings. Braden ≤18 triggers pressure injury prevention protocol.

Offloading & Prevention

Reposition: 2-hourly minimum for high-risk patients; 30-degree tilt (not 90-degree lateral) to avoid trochanteric pressure
Reactive foam or alternating pressure mattresses for Braden ≤18
Heel protectors — elevate heels off mattress completely (float the heels)
Skin: keep clean and dry, moisture-barrier cream for incontinence, avoid massage over bony prominences

Wound Bed Preparation — TIME Framework

Tissue
Debride non-viable tissue: autolytic/enzymatic/sharp/surgical

Infection/Inflammation
Treat clinical infection; reduce bioburden; antimicrobial dressings

Moisture
Moist wound healing; manage exudate — too dry or too wet both impede healing

Edge/Epithelium
Assess wound edge advancement; consider skin grafting if edge not advancing in 4 weeks

Dressing Selection Guide

Dressing Type	Indication	Avoid
Hydrocolloid	Stage II, minimal-moderate exudate, autolytic debridement	Heavy exudate, infected wounds, Stage III/IV
Foam	Moderate-heavy exudate, Stage II/III, cavity (cavity foam)	Dry/necrotic wounds
Alginate	Heavy exudate, bleeding wounds (haemostatic), cavity wounds	Dry wounds, Stage I, wounds with sinuses (packing risk)
Hydrofibre (Aquacel)	Heavy exudate, infected wounds — forms gel, maintains moisture	Dry wounds
Silicone (Mepitel)	Fragile skin, epidermolysis bullosa, donor sites, burns	Heavy exudate (use silicone foam instead)
Antimicrobial silver	Infected/critically colonised wounds, chronic non-healing wounds	Clean healing wounds — cytotoxic to fibroblasts if overused
Honey (Medihoney)	Infected, malodorous, sloughy wounds — antimicrobial, debriding	Allergy to bee products, heavy exudate alone

Negative Pressure Wound Therapy (NPWT / VAC)

Indications

Stage III/IV pressure injuries
Diabetic foot ulcers — post-surgical or traumatic
Dehisced surgical wounds
Open abdominal wounds / laparostomy
Skin graft fixation and take optimisation

How it works

Continuous or intermittent negative pressure (typically -125 mmHg)
Reduces oedema, removes exudate, promotes granulation tissue
Draws wound edges together (macro-deformation)

Contraindications

Malignancy in or near wound — promotes tumour growth
Unexplored fistula / enteric fistula
Necrotic tissue with eschar — must debride first
Untreated osteomyelitis
Active bleeding / anticoagulated patient — caution

Nursing Monitoring

Check seal integrity — leaks lose therapeutic pressure
Monitor canister output — excessive sudden blood = alarm
Change foam/gauze every 48–72h (or per manufacturer)
Pain assessment — intermittent mode more painful than continuous

Leg Ulcers — Venous vs Arterial vs Mixed

Feature	Venous	Arterial	Mixed
Location	Medial gaiter (medial malleolus)	Lateral, pressure points, toes	Variable
Wound bed	Shallow, exudative, granulating	Deep, pale/grey/necrotic, dry	Mixed features
Edges	Irregular, sloping	Punched-out, well-defined	Variable
Pain	Dull ache, relieved by elevation	Severe, worse at night/elevation (rest pain)	Mixed
Surrounding skin	Lipodermatosclerosis, haemosiderin staining, varicosities	Hairless, shiny, cold, pale/dusky	Mixed
ABPI	0.8–1.3 (normal)	<0.5 (severe ischaemia)	0.5–0.8
Compression	HIGH compression (40mmHg) — first-line	CONTRAINDICATED if ABPI <0.5	Modified compression only if ABPI >0.6

ABPI (Ankle-Brachial Pressure Index) MUST be assessed before applying compression therapy. Use handheld Doppler. Normal ABPI 0.9–1.3. <0.9 = peripheral arterial disease. Never apply full compression (25–40 mmHg) to ABPI <0.8 without vascular review.

Heat-Related Skin Conditions — GCC Outdoor Workers

Miliaria (Prickly Heat)

Crystallina: superficial eccrine duct blockage — clear vesicles, no inflammation. Self-limiting
Rubra: deeper — erythematous papulovesicles, pruritic/stinging. Most common
Profunda: deepest — skin-coloured papules. Risk of heat exhaustion (sweat impaired)
Rx: cool environment, loose cotton clothing, calamine lotion, mild TCS for rubra

Sunburn

UVB-induced erythema, oedema, pain — peaks 12–24h after exposure
GCC: even darker skin types (III-VI) WILL burn — less visible erythema but still DNA damage
Rx: cool compresses, emollients, ibuprofen, SPF 30-50 prevention

GCC Outdoor Worker Risk:
Summer ban on outdoor work 12:30–15:00 (June-Sept) — enforced in UAE, Qatar, Saudi Arabia. Skin conditions UNDERREPORTED in migrant workers due to fear of job loss.

Photosensitivity in dark skin: Erythema less visible — assess warmth, oedema, patient-reported burning/pain. Risk of missing significant burns. Higher SPF compliance messaging needed.

Nursing Role — Outdoor Workers

Health education: SPF 50+, protective clothing, hydration
Sunscreen prescription — available OTC in GCC pharmacies
Screen for occupational dermatoses during annual health checks
Refer to occupational health for persistent/severe conditions

GCC-Specific Skin Conditions

Animal-Contact Conditions

Camel Pox: Poxvirus — papules/pustules on hands/arms from contact with infected camels. Zoonotic. Notify public health. Rare human-to-human spread.
Orf (Contagious Ecthyma): Parapoxvirus from sheep/goats — common during Eid Al-Adha (mass slaughter). Solitary nodule on hand that progresses through 6 stages over 6 weeks. Self-limiting. Immunocompromised — giant orf.
Desert sores (tropical ulcer): Mixed bacterial infection on lower limbs — found in areas with contaminated soil/water

Climate-Related Conditions

Tinea imbricata: Trichophyton concentricum — concentric ring pattern, SE Asian migrants in GCC, oral terbinafine extended course
Photodermatoses: Polymorphic light eruption — very common in GCC given sun exposure; pruritic papules/vesicles on exposed skin
Chromhidrosis: Coloured sweat — apocrine (face/axillae) — rare; eccrine blue sweat from copper exposure in industrial workers

Cultural & Religious Skin Considerations in GCC

Henna Dermatitis

Natural henna (Lawsonia inermis) — orange/brown colour, low sensitisation risk
Black henna — contains paraphenylenediamine (PPD) to darken/speed up colour. HIGH risk of severe ACD — can cause scarring
PPD allergy also cross-reacts with: hair dye, benzocaine, sulfonamides, procaine — important surgical/drug allergy implication
Patch test before henna application — educate patients about black henna risk

Bakhoor/Oud/Perfume Reactions

Arabic perfume oils (attar/oud) — applied directly to skin — fragrance mix allergy common
Bakhoor (incense burning) — airborne contact dermatitis possible
Cinnamal, limonene, linalool — common fragrance allergens

Vitiligo — GCC Psychosocial Context

Vitiligo (autoimmune depigmentation) has significant psychosocial impact in GCC due to visibility on darker skin types. Important Islamic context: vitiligo is NOT contagious — educate patients, families, communities. Historical stigma (baras = leprosy confusion) contributes to social isolation. Psychological support, patient education, and community de-stigmatisation are core nursing roles.

Rx: phototherapy (NB-UVB — gold standard), topical tacrolimus for face/sensitive areas, camouflage cosmetics, JAK inhibitors (ruxolitinib cream) — newer approval.

Modesty & Gender Considerations

Female patients may prefer female nurses for skin examination — accommodate where possible
Full skin examination may require sensitive communication and privacy
Body image concerns from religious/cultural attire interactions with skin conditions (hijab dermatitis, friction under abaya)

GCC Regulatory & Nursing Competencies

Licensing Body Frameworks

Country	Body	Dermatology Relevance
Dubai	DHA	Wound care competency assessment; dermatology nursing clinical attachment requirements
Abu Dhabi	DOH	Scope of practice for nurses in wound care, IV antibiotics
Saudi Arabia	SCFHS	Wound care certification program — mandatory for wound care nurses
Qatar	QCHP	Nursing licence with specialisation pathway; CPD requirements
All GCC	MOH variations	MCQ licensing exams — dermatology questions included

SCFHS Wound Care Certification

Structured wound care program — recognised across Saudi Arabia
Covers: pressure injury prevention, chronic wound management, dressing selection, diabetic foot care
CPD hours required for renewal
Increasingly required for wound care specialist nurse roles in MOH hospitals

Nursing Scope in GCC Dermatology:
Wound care, dressing changes, phototherapy operation (NB-UVB units), topical treatment education, patch test preparation (under dermatologist supervision), biopsy preparation, patient education — cultural skin health promotion.

GCC Exam Prep — DHA / MOH / SCFHS / QCHP Style MCQs

Q1. A 35-year-old male construction worker in Dubai presents with intensely pruritic, erythematous papulovesicles in the webspaces of his fingers and on his wrists. His dormitory roommates have similar symptoms. What is the most appropriate FIRST treatment step?

Prescribe oral flucloxacillin for all symptomatic contacts
Apply permethrin 5% cream from neck to toe, treat ALL household contacts on the SAME day
Apply hydrocortisone 1% cream twice daily for 2 weeks
Refer to dermatology and await patch testing results

Answer: B — This presentation is classic scabies (pruritic burrows in webspaces, household spread). Permethrin 5% is first-line; simultaneous treatment of ALL contacts prevents reinfestation. Topical steroids alone will worsen scabies. Flucloxacillin is for bacterial infections.

Q2. A 52-year-old patient on carbamazepine for epilepsy develops painful mucosal erosions, target lesions, and skin detachment affecting 8% of body surface area. What is the PRIORITY nursing action?

Apply potent topical corticosteroids to all affected areas immediately
Stop the carbamazepine and arrange urgent ophthalmology review
Commence oral antihistamines and observe for 24 hours
Apply silver sulfadiazine cream and discharge with outpatient follow-up

Answer: B — 8% BSA detachment = Stevens-Johnson Syndrome. STOP causative drug IMMEDIATELY (carbamazepine). Ophthalmology review is urgent (ocular involvement leads to blindness). Topical steroids are controversial and not the priority. This patient needs ICU/burns unit admission, not discharge.

Q3. When performing ABPI (Ankle-Brachial Pressure Index) before applying compression bandaging to a patient with a venous leg ulcer, a reading of 0.6 is obtained. What is the CORRECT action?

Apply full 4-layer high compression bandaging (40 mmHg) as planned
Do not apply any compression and refer immediately to vascular surgery
Apply modified/reduced compression (15–20 mmHg) only after vascular review
Obtain a repeat ABPI in 4 hours and proceed if unchanged

Answer: C — ABPI 0.5–0.8 indicates mixed aetiology (venous + arterial). Full compression is CONTRAINDICATED (ABPI <0.8). Modified reduced compression (15–20 mmHg) may be used after vascular assessment confirms safety. ABPI <0.5 = severe ischaemia — no compression at all.

Q4. A patient with a chronic Stage III pressure injury has a Braden Scale score of 10. The wound bed is covered with yellow slough. Using the TIME framework, which is the FIRST priority intervention?

Apply a silver antimicrobial dressing to address infection risk
Commence negative pressure wound therapy (VAC) immediately
Debride the necrotic/sloughy tissue to prepare the wound bed (Tissue)
Apply a hydrocolloid dressing to maintain moisture balance

Answer: C — TIME framework: T (Tissue) is addressed first — non-viable sloughy tissue must be debrided before other interventions can be effective. A Braden score of 10 = high risk; NPWT may be indicated but debridement comes first. Hydrocolloid is inappropriate for Stage III with heavy slough.

Q5. A Saudi nurse is counselling a patient newly diagnosed with vitiligo. The patient's family is concerned about contagion. Which statement is MOST important to include in patient education?

Vitiligo is caused by a fungal infection and can spread through skin contact
Vitiligo is an autoimmune condition — it is NOT contagious and cannot be passed to others
The condition is linked to poor hygiene and will resolve with regular washing
Patients with vitiligo should be isolated in shared spaces to prevent spread

Answer: B — Vitiligo is an autoimmune destruction of melanocytes. It is completely non-contagious. This is especially important in GCC cultural context where historical stigma (confusion with leprosy/baras) causes social isolation. Education should address the family and community. Isolation is incorrect and harmful.

Dermatology Nursing Guide GCC