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Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. 

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number.  To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Alopecia

Not all treatment options may be listed in this guidance. Please refer to local formulary for a complete list.

Treatment/ therapy

Alopecia may be scarring or non-scarring, localised or diffuse, inflamed or non-inflamed 

Diffuse non-scarring 

  • Physiological: normal ageing process 
  • Female pattern hair loss (FPHL)- thinning over crown 
  • Telogen effluvium/ excessive shedding occurs three–four months after pregnancy/ other major event 
  • May be component of polycystic ovarian disease in young women 
  • Consider any new medications 

 

Diffuse non-scarring

Localised non-scarring 

  • Alopecia areata 
  • Patchy hair loss with exclamation mark hair 

Localised non-scarring

Diffuse inflamed non-scarring 

  • Consider seborrhoeic dermatitis or psoriasis (may also rarely cause scarring) 

 

Localised inflamed non-scarring 

  • Consider tinea infection (may also cause scarring) 
  • Consider psoriasis or seborrhoeic dermatitis 

Local inflamed non-scarring

Scarring 

  • Loss of hair follicles with or without inflammation and accompanied by scarring 
  • Local or diffuse 
  • Causes include: Lichen planus

Scarring

 Scarring  Scarring

Referral Management

  • Dermatology Referral Criteria 
  • Inflammatory scarring alopecia 
  • Diagnostic uncertainty 
  • Persistent or extensive alopecia (scarring or non-scarring) 
  • Hairpiece or wig prescription for alopecia caused by trauma or disease resulting in psychological distress (if available) 

Clinical tips

Diffuse non-scarring 

  • Reassure patients with mild FPHL that condition is physiological 
  • Reassure patients that Telogen effluvium will recover spontaneously 
  • Diffuse alopecia: check full blood count, ferritin and thyroid function 
  • Patients with severe degree of alopecia caused by disease can be considered for NHS wig prescription 

Localised non-scarring 

  • Reassure patients with alopecia areata that spontaneous regrowth is likely 
  • Generally good outcome in patients with short history and limited extent 
  • Trial of potent topical steroid lotion for three months 

Diffuse inflamed non-scarring 

Treatment: 

  • Coal tar + salicylic acid ointment ( eg Cocois/Sebco) 
  • Anti-fungal shampoo ( eg ketoconazole) 
  • Topical steroid lotion/mousse/foam 

Localised inflamed non-scarring 

  • Send hair pluckings to mycology lab 
  • If dermatophyte infection confirmed, treat with oral terbinafine 
  • Treat as for diffuse inflamed non-scarring if psoriasis or seborrhoeic dermatitis 

Scarring 

  • Requires secondary care referral 

Patient information resources

  1. NHS Inform: www.nhsinform.scot 
  2. Alopecia help and advice Scotland: https://www.alopecia.org.uk/ 
  3. British Association of Dermatologists: http://www.bad.org.uk/for-the-public/patient-information-leaflets 
  4. Dermnet NZ: www.dermnetnz.org 

Editorial Information

Author(s): Adapted from Dermatology Patient Pathways.

Co-Author(s): NHS Scotland, Scottish Dermatology Society.