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Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

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 update to the latest release:

 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.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Nummular discoid eczema

Nummular eczema/discoid eczema: Cutaneous eruption characterized by coin-shaped plaques of eczema. The plaques usually occur on the extensor surfaces of the extremities, but the face and trunk may also be involved. Plaques are extremely itchy. Each plaque begins as a small group of red spots and tiny bumps (papules) or blisters (vesicles), which cluster together and grow rapidly into a red, swollen, round plaque which often weeps or develops a crusted surface. Plaques may become infected at a later stage. After a while the plaques become dry and scaly. 

The cause is unknown. Prevalence is around 1 in 500 people. There is a peak incidence in both males and females of around 50-65 years of age. It is less commonly seen in children. The condition can respond poorly to treatment compared to other forms of eczema, and typically requires the use of potent topical steroids. 

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

Treatment/ therapy

Mild: ... Slight but definite erythema (pink), slight but definite induration/papulation, and/or slight but definite lichenification. No oozing or crusting. Disease limited in extent.   

  • Advise patient on the avoidance of irritants (e.g. soap). 
  • Prescribe generous amounts of emollients; advise frequent and liberal use. 
  • Moderate potency topical corticosteroids eg.  betamethasone valerate 0.025% or clobetasone butyrate 0.05% 

Moderate: … Clearly perceptible erythema (dull red), clearly perceptible induration/papulation, and/or clearly perceptible lichenification. Oozing and crusting may be present. Disease fairly widespread in extent. 

  • Advise patient on the avoidance of irritants (e.g. soap). 
  • Prescribe generous amounts of emollients; advise frequent and liberal use. 
  • Potent topical corticosteroids eg. betamethasone valerate 0.1% or mometasone 0.1%. If no improvement, may require the use of clobetasol propionate 0.05% (super potent) daily for up to 2 weeks, then review (trunk and limbs, not face and flexures). 
  • Sedating antihistamine at night if sleep disturbed and non-sedating antihistamine for daytime itch if required. 
  • Treatment of secondary infection: antibiotic as appropriate according to swab result. 

Severe: … Marked erythema (deep or bright red), marked induration/papulation, and/or marked lichenification. Oozing or crusting may be present. Disease is widespread in extent. 

  • Advise patient on the avoidance of irritants (e.g. soap). 
  • Prescribe generous amounts of emollients; advise frequent and liberal use. 
  • Refer to dermatologist. Commence treatment in primary care whilst waiting for appointment. 
  • Super potent topical corticosteroids eg. clobetasol propionate 0.05% daily for up to 2 weeks, then review (trunk and limbs, not face and flexures). 
  • Sedating antihistamine at night if sleep disturbed and non-sedating antihistamine for daytime itch if required.. 
  • Treatment of secondary infection: antibiotic as appropriate according to swab result. 
  • Other treatments may be required, such as phototherapy or oral immunosuppressant drugs. 

Referral Management

Mild: ... Slight but definite erythema (pink), slight but definite induration/papulation, and/or slight but definite lichenification. No oozing or crusting. Disease limited in extent.

Manage in primary care; do not refer.  

Seek advice and guidance where there is diagnostic uncertainty. 

Moderate: … Clearly perceptible erythema (dull red), clearly perceptible induration/papulation, and/or clearly perceptible lichenification. Oozing and crusting may be present. Disease fairly widespread in extent. 

Manage in primary care.  

Refer to secondary care service if multiple treatments in primary care have failed. 

 

Severe: … Marked erythema (deep or bright red), marked induration/papulation, and/or marked lichenification. Oozing or crusting may be present. Disease is widespread in extent.

Refer to dermatologist if the patient has not responded to optimum topical therapy (including super potent topical corticosteroids). Could be offered a video consultation. 

Clinical resources

https://cks.nice.org.uk/topics/eczema-atopic/ 

https://cks.nice.org.uk/topics/fungal-skin-infection-body-groin/diagnosis/differential-diagnosis/ 

PCDS guidance – discoid/nummular eczema: http://www.pcds.org.uk/clinical-guidance/eczema-discoid-syn.-nummular-eczema  

Clinical tips

  • Initially, these plaques are often swollen, and ooze fluid. The appearance can be confused with secondary infection. 
  • Antibiotics are rarely indicated for discoid eczema.  
  • Plaques tend to be very itchy, particularly at night. 
  • Over time, the plaques may become dry, crusty, cracked and flaky. The centre of the plaque also sometimes clears, leaving a ring of discoloured skin that can be mistaken for ringworm. Tinea would be suggested by asymmetrical distribution and can be confirmed with skin scrapings for mycology. Tinea corporis is not commonly seen in adults. 
  • Discoid eczema usually requires at least potent topical corticosteroids. 
  • On lighter skin, plaques will be pink or red. On darker skin, plaques can be dark brown or paler than the skin around them. Discolouration can persist for months after the condition has cleared. 
  • Differs from psoriasis in that plaques tend to be a lighter red, the border fades gradually at the periphery and the presence of exudate / crust as opposed to scale. 

Patient information resources

  1. Discoid eczema – BAD Patient info leaflet
  2. Patient.info leaflet – Discoid eczema 
  3. NHS Choices – Discoid eczema- https://www.nhs.uk/conditions/discoid-eczema/  

ICD search categories

Inflammatory 

ICD11 code - EA82 

Editorial Information

Last reviewed: 23/05/2023

Next review date: 23/05/2025

Author(s): Adapted from the BAD Referral Guidelines.

Version: BAD 1

Co-Author(s): Publisher: Centre for Sustainable Delivery, Scottish Dermatological Society.

Approved By: Scottish Dermatological Society