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Critical thinking and diagnostic reasoning when advanced practitioners assess and treat skin conditions

09 December 2021
Volume 30 · Issue 22


Advanced clinical practitioner (ACP) roles require a broad range of knowledge of both medical and surgical medicine and the ability to work autonomously in a variety of settings. Despite around half of the UK adult population presenting with a skin condition requiring attention, this is something many ACPs feel unprepared to be consulted on. However, due to the complexity and large number of potential diagnoses, it is imperative that ACPs develop their confidence and knowledge to diagnosis, request investigations and initiate treatment for a patient with a skin complaint. In the first part of this clinical review the authors presented the key elements of history taking, consultation and assessment of the skin. This second clinical review discusses the main differential diagnoses, mimics, common investigations and treatments. This article is designed to support novice ACPs from acute hospital settings to primary care to develop a foundation of understanding in the main diagnosis and treatment options that should be considered following a clinical assessment of patients’ skin outside the dermatology setting.

In the past two decades the role of the advanced clinical practitioner (ACP) has emerged to relieve pressures within the healthcare workforce (Reynolds and Mortimore, 2021). Unless the ACP works within a specific specialty, ACPs require a broad knowledge of many specialisms, both medical and surgical, and an ability to work both within primary and secondary care (Reynolds and Mortimore, 2021). Therefore this clinical review, the second in a series of two articles, is designed to support ACPs across acute hospital settings and primary care in differential diagnosis, mimicking conditions, common investigations and treatment options outside a dermatology setting. Many ACPs feel uncomfortable with assessing and managing skin conditions because it is a complex specialty with a large number of potential diagnoses (over 2000) (Levell et al, 2013). However, those with less familiarity with dermatological conditions can develop their knowledge and experience and provide care for those with dermatological complaints.

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