T18-10_Scar_revision_skin_resurfacing

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					REF: T18/10




General Commissioning Policy Statement

Treatment
                        Scar Revision and Skin Resurfacing
For the                 Severe Scarring
treatment of
Background              This commissioning policy is needed because scar revision is
                        currently on the PCT list for treatments not routinely
                        commissioned and requests are thus currently considered via the
                        Exceptional Treatments process.

Commissioning Scar revision that is considered to be cosmetic will not be
position      routinely commissioned by NHS Hull, as cosmetic treatments are
              low priority.

                        Scar revision may only be considered in exceptional
                        circumstances in individuals where:
                             the scar has resulted from previous NHS surgery where the
                               quality of work has been poor
                        OR
                             scarring is due to burns OR severe trauma
                        AND
                             there is evidence of significant clinical symptoms, psycho-
                               social problems or functional impairment and a clinical
                               opinion that scar revision is likely to ameliorate these
                               problems.

                        Skin Resurfacing involves removing the top layer of skin with an
                        aim to make it look smoother and healthier. Scarring and
                        permanent discolouration of skin are rare complications.

                        Skin Resurfacing treatments (by techniques including laser,
                        dermabrasion and chemical peels) requested for skin
                        rejuvenation or other cosmetic purposes are not commissioned
                        by NHS Hull as cosmetic treatments are considered low priority.

                        Skin resurfacing may be considered on an exceptional case by
                        case basis for:
                             post traumatic scarring
                             severe facial post-acne scarring, only when the active
                               disease is controlled.

                        Requests for treatment will need to provide evidence of:
                           severe psychological distress, OR
                           adverse physical health effects
                        AND
                           compelling reasons to believe that skin resurfacing will
                             lead to an improvement in health status.

  Notes
      1.   This Policy will be reviewed in the light of new evidence, or guidance from NICE.
      2.   General Commissioning Policy Statements are agreed by the Commissioning Executive on behalf of NHS Hull.
REF: T18/10


                        All requests for scar revision and skin resurfacing should include
                        a detailed account of the specific problems encountered along
                        with any previous referrals, treatments and outcomes.
                        Photographic evidence in support of the individual case may
                        assist the decision making process.

                        (NB. Treatment for Port Wine Stains on the face and neck is
                        subject to a separate Policy statement).

Effective from          July 2010
Summary of              Scarring can arise from trauma, surgery or skin conditions such
evidence /              as severe acne. Scar revision is designed to improve or disguise
rationale               the appearance of scarring. Scars from an injury or operation
                        tend to improve on their own with time and therefore surgery to
                        revise this type of scar is not usually carried out for at least six
                        months afterwards. Scar revisions can be carried out under
                        either general or local anaesthesia. Treatments vary according to
                        the type and size of the scar. Some scars are cut out and re-
                        stitched carefully. Other scars are removed by abrasion or laser
                        surgery and require no stitching.

                        In line with the Modernisation Agency guidelines for Plastic
                        Surgery (Ref 1), cosmetic surgery (surgery undertaken
                        exclusively to improve appearance) is excluded from NHS
                        provision in the absence of previous trauma, disease or
                        congenital deformity. In exceptional circumstances and after
                        consideration by the ETP, NHS Hull may consider individual
                        cases in line with this policy.

                        Scarring and keloid formation are possible consequences of
                        acne, especially in nodulo-cystic acne. A range of laser
                        treatments has been used for the management of acne scarring.
                        A Cochrane systematic review in 2001 concluded that even
                        though the available studies of laser resurfacing for acne scarring
                        were poor, there was some evidence to suggest that the
                        treatment was effective (Jordan et al 2001). There was little
                        evidence at that time of which type of laser worked best for which
                        type of scarring. More recent studies have considered the type of
                        laser and the method of use (Woo et al 2004) but there remains a
                        paucity of good controlled studies. (Ref 2)

Date                    July 22nd 2010

Policy to be            July 2012
reviewed by
Contact for this        Julia Mizon,
policy                  Assistant Director (Contracting and Performance), NHS Hull
                        Julia.Mizon@hullpct.nhs.uk




  Notes
      1.   This Policy will be reviewed in the light of new evidence, or guidance from NICE.
      2.   General Commissioning Policy Statements are agreed by the Commissioning Executive on behalf of NHS Hull.
REF: T18/10



Refs:
1. Commissioning Guide - Referrals and Guidelines in Plastic Surgery (NHS
   Modernisation Agency 2005).

2. Schofield, Grindlay and Williams (2009). Skin Conditions In The UK: a Health Care
   Needs Assessment. Centre of Evidence Based Dermatology, University of
   Nottingham, UK




   Notes
       1.   This Policy will be reviewed in the light of new evidence, or guidance from NICE.
       2.   General Commissioning Policy Statements are agreed by the Commissioning Executive on behalf of NHS Hull.

				
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