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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.

Pruritus

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

Treatment/ therapy

Generalised pruritus 

May occur without any underlying skin disease. Xerosis/dry skin in the elderly is one of the commonest caused of itch. 

In the absence of overt skin disease consider an underlying diagnosis  such as: 

  • Diabetes mellitus 
  • Anaemia / Iron deficiency 
  • Thyroid dysfunction 
  • Liver disease 
  • Medication induced (ie opiates) 

Rarely: 

  • Haematological malignancy eg Lymphoma 
  • Other malignancies 
  • Psychogenic itch 
  • HIV 

Vulval and perianal pruritus 

Consider the following diagnoses: 

  • Candidiasis 
  • Dermatophyte infection 
  • Irritant dermatitis or allergic contact dermatitis 
  • Lichen simplex 
  • Lichen sclerosis 
  • Infestation with thread worms 
  • Intra-epithelial neoplasia — ask about previous history of anogenital warts or cervical intra-epithelial neoplasm

Referral Management

Dermatology Referral Criteria 

Generalised pruritus 

  • Unresponsive to management 
  • Diagnostic uncertainty 

Vulval and perianal pruritus 

  • Diagnosis uncertainty 
  • Uncontrolled symptoms 
  • If contact allergy suspected 

Clinical tips

Generalised pruritus Treat any underlying disease Regular emollient and soap substitutes Oral antihistamines (sedating type may be more helpful in itch) Consider menthol in aqueous cream (0.5%- 2%) 

  

Investigations as appropriate 

  • Glucose 
  • Renal Function 
  • Full blood count 
  • Ferritin 
  • Liver Function tests 
  • Thyroid Function tests 
  • Medication review 

  

If indicated by history 

  • Chest x-ray 
  • Abdominal ultrasound 
  • HIV test 

Vulval and perianal pruritus Investigations as appropriate 

  • Urinalysis for glycosuria 
  • Swab for yeasts 
  • Stool sample for ova and parasites 

Management 

  • Emollients, soap substitutes and avoidance of irritants 
  • Treat the underlying disease where applicable 
  • Mild / moderate steroid plus antifungal / antibacterial 
  • Potent topical steroid may be required for limited period in lichen simplex and lichen sclerosis 

Patient information resources

Editorial Information

Author(s): Adapted from Dermatology Patient Pathways.

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