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Skin

Please see below for the policies relating to skin. To view the policy, patient leaflet and additional information, please click on the relevant heading.


  • Alopecia

    What is alopecia?

    Alopecia is the general medical term for hair loss. Hair loss varies from male baldness to irregular patches of baldness in men and women.

    Patchy baldness or alopecia can occur at any age, although it’s more common in people aged 15-29. It affects one or two people in every 1,000 in the UK.

    Not normally funded treatment or procedure:

    Treatment for alopecia is not usually funded by the patient’s local NHS commissioning organisation. This is because surgical treatment for hair loss is deemed to be a cosmetic procedure.

    The British Association Dermatologists state that not treating alopecia is an appropriate option for many patients. In some cases, the condition may spontaneously stop, with only limited patches of hair loss occurring.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    • For more information search for ‘hair loss treatment’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
  • Botox injections

    What are botox injections?

    Botox injections for the ageing face are used to help relax facial muscles and make lines and wrinkles less obvious.

    During the procedure, the patient’s skin is cleaned and small amounts of botox are injected into the area to be treated. Several injections are usually needed at different sites. The injections usually take effect about three to five days after treatment and it can take up to two weeks for the full effect to be realised. The effects generally last for about three to four months.

    Not normally funded treatment or procedure:

    Botox injections for the ageing face are not usually funded by the patient’s local NHS commissioning organisation. This is because botox injections for this purpose are considered to be a cosmetic procedure.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation.

    See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    For patients wishing to have botox injections, it is worth remembering that the effect isn’t permanent, there’s no guarantee that the desired effect will be achieved and it is not normally funded by the patient’s local NHS commissioning organisation.

    • For more information search for ‘botox injections’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
  • Cosmetic Surgery Botulinum Toxin Injection for the Ageing Face
  • Chemical peel

    What are dermabrasions, chemical peels and laser treatments?  

    Chemical peels are liquids brushed on to the face to remove dead skin cells and stimulate the growth of new cells. Dermabrasion involves removing the top layer of skin, either using lasers or a specially made brush. This procedure is to help improve the skins appearance. Laser treatment can be used to treat mild to moderate acne scarring.

    There are two types of laser treatment:

    • One where lasers are used to remove a small patch of skin around the scar to produce a new, smooth-looking area of skin (ablative laser treatment)
    • The other is where lasers are used to stimulate the growth of new protein in the skin (collagen), which helps to repair some of the damage caused by scarring, and improves the appearance of the skin (non-ablative laser treatment).

    Not normally funded treatment or procedure:

    Dermabrasions, chemical peels and laser treatments are not usually funded by the patient’s local NHS commissioning organisation. This is because, purely removal of surplus skin or fat irrespective of site on the body is deemed to be a cosmetic procedure.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded.

    The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    • For more information search for ‘acne scarring’ and ‘chemical peels’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
  • Excessive sweating (hyperhidrosis)

    What is excessive sweating?

    Normal sweating helps to keep the body temperature steady in hot weather, during a high temperature (fever) or during exercise. Excessive sweating (hyperhidrosis) means the patient sweats more than normal. 

    Excessive sweating can be challenging to treat and it may take a while to find the best treatment. Treatment options can include a powerful muscle relaxer (botox) but this is only licensed for underarm sweating as use for excessive sweating on hands and feet and may cause muscle weakness and pain.

    Alternative, less invasive treatments are recommended first. These may include:

    • Lifestyle changes
    • Stronger antiperspirants
    • Prescribing nervous system blocking drugs (anticholinergics)
    • Referral to a dermatologist.

    Not normally funded treatment or procedure:

    The use of botox (botulinum toxin, type A) for excessive sweating is not normally funded by the patient’s local NHS commissioning organisation. This is because botox (botulinum toxin) is not commonly used in the palms and soles because it can cause temporary weakness of hand and foot muscles and is painful.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    • For more information search ‘hyperhidrosis excessive sweating’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
  • Hair removal or depilation

    What is excessive hair removal?

    Hair removal can be used for patients with excess hair (hirsuitism) in a normal distribution pattern, or for abnormally placed hair. It is usually achieved permanently by electrolysis or laser therapy. Excess hair (or hair not in a usual pattern or place) essentially means that an individual, usually a female patient, grows too much body or facial hair in a male pattern.

    Although it sometimes occurs in males, it is more difficult to detect because of the wide range of normal hair growth in men. Excess hair affects approximately 10% of women in Western societies and is commoner in those of Mediterranean or Middle-Eastern descent.

    It is usually caused by high levels of male hormones and additional symptoms may be irregular periods, acne, deepening of voice and baldness. The British Association of Dermatologists advises that there are a range of treatment options:

    • Medical treatments: prescription hair removal cream (eflornithine) cream, or a range of hormone altering medication (anti-androgens)
    • Self-care: shaving, waxing, hair removal creams and bleaching creams
    • Physical treatments: electrolysis, or laser and intense pulsed light (IPL) treatments.

    Patient eligibility criteria:

    The patient's local NHS commissioning organisations will only fund this treatment if the patient meets any of the following criteria:

    • If the patient has undergone reconstructive surgery leading to abnormally located hair-bearing skin. For example, if reconstructive surgery has led to hair growing in places it would not normally do so such as in the mouth, or a skin graft that has caused visible excess hair growth
    • If the patient is undergoing treatment for small hole or tunnel in the skin, usually caused by loose hair piercing through the skin in the cleft of the buttocks, where the buttocks separate (pilonidal sinuses).

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    • For more information, search for ‘hirsuitism’ and ‘laser hair removal’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
  • Liposuction - cosmetic

    What is liposuction?

    Liposuction (also known as liposculpture) is a surgical procedure performed to improve body shape by removing unwanted fat from areas of the body such as abdomen, hips, thighs, calves, ankles, upper arms, chin, neck and back.

    Not normally funded treatment or procedure:

    Liposuction is not usually funded by the patient’s local NHS commissioning organisation. This is because purely removal of unwanted fat from the above areas is considered to be a cosmetic procedure.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation.

    See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    • For more information search for ‘liposuction’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
  • Liposuction - Lipoedema

    Liposuction is an operation which involves a suction technique to remove fat from certain areas of the body which haven’t responded to exercise and diet. As liposuction is normally seen as a cosmetic procedure, it is not normally available through the NHS. However, liposuction can sometimes be used by the NHS to treat certain health conditions.

    Lipoedema:

    Lipoedema is a long-term condition where an unusual build-up of fat in the legs, thighs and buttocks, and sometimes in the arms, occurs which makes them increase in size. The condition usually only affects women, although in rare cases it can also affect men.

    Causes of lipoedema:

    The cause of lipoedema is not known, however in some cases there's a family history of the condition and the genes inherited from your parents play a role. Lipoedema tends to start at puberty or at other times of hormonal change, such as during pregnancy or menopause. This suggests that hormones may also have an influence, however the build-up of fat cells is often worse in obese people. Lipoedema is not caused by obesityand can affect people who are a healthy weight.

    Treatments:

    There's been little research into lipoedema, so there's some uncertainty about the best way to treat the condition. If you have lipoedema it's important to avoid significant weight gain and obesity because putting on weight will make the fatty swelling worse. Compression tights are helpful for some people because they support the fatty swelling and may reduce the pain. Liposuction can be a surgical option for the removal of fat.

    Non-surgical treatments

    Non-surgical treatments can sometimes help to improve pain, tenderness and prevent orreduce lipoedema by improving the shape of affected limbs – although they often have littleeffect on the fatty tissue.Several different treatments are designed to improve the flow and drainage of fluid in bodytissues, such as:

    • Compression therapy – wearing bandages or garments that squeeze the affected limbs
    • Exercise – usually low-impact exercises, such as swimming and cycling
    • Massage – techniques that help encourage the flow of fluid through your body.

    Treatments which won’t help

    Some treatments used for some types of tissue swelling are generally unhelpful for lipoedema. Lipoedema doesn't respond to:

    • Raising the legs
    • Diuretics (tablets to get rid of excess fluid)
    • Dieting – this usually tends to result in a loss of fat from areas which are not affected bylipoedema.

    Eligibility criteria:

    Due to a lack of evidence, liposuction for patients with lipoedema is Not Routinely Commissioned.

    This means the patient’s NHS commissioning organisation (CCG), who are responsible for purchasing healthcare services on behalf of the population, will only fund the treatment if
    an Individual Funding Request (IFR) application has exceptional clinical need and the CCG supports this.

    Advice and further guidance:

  • Liposuction - lymphoedema

    Liposuction is an operation which involves a suction technique to remove fat from certain areas of the body. This is done by inserting a thin tube through small cuts in the skin to draw fat out from the affected limbs, which helps to reduce the size of the limb. As liposuction is normally seen as a cosmetic procedure, it is not normally available through the NHS. However, liposuction can sometimes be used to treat certain health conditions.

    Lymphoedema:

    Lymphoedema is a long-term (chronic) condition which causes swelling in the body's tissues. It can affect any part of the body; however, it usually develops in the arms or legs when the lymphatic system doesn't work properly.

    The lymphatic system:

    The lymphatic system is part of the immune system. It is made up of a network of tissues, organs and glands throughout the body which help to transport ‘lymph’, an infection fighting fluid around the body. It also helps to remove excess fluid and fats from our bodies. When it doesn’t work properly, it can cause swelling and encourage body fat to grow.

    Treatment:

    Conservative treatment for lymphoedema is the first choice and the patient should be referredto a specialist lymphoedema service for assessment. Current conservative treatments for lymphoedema includes:

    • Decongestive Lymphatic Therapy (DLT) which combines MLD massage with tightbandaging, good skin care, decongestive and exercise. Once DLT sessions are stopped, the patient is fitted with a custom-made compression garment, which is worn everyday.

    Eligibility criteria:

    Patients with lymphoedema will be considered for funding for liposuction if they have not responded to conservative treatments of lymphoedema. If conservative treatment fails, the patient’s specialist lymphoedema multidisciplinary team may consider recommending the patient for liposuction surgery to treat lymphoedema.This means the patient’s NHS commissioning organisation (CCG), who is responsible for buying healthcare services on behalf of patients, will only fund the treatment if the patient meets the above eligibility criteria or if an Individual Funding Request (IFR) application has shown exceptional clinical need and the CCG supports this.

    Advice and further guidance:

  • Medical removal of scars

    What are the medical and surgical treatments for scars?

    There are several different types of scars including:

    • Flat, pale scars – these are the most common type of scar and can be red or dark and raised after the wound has healed, but will become paler and flatter naturally over time
    • Red, raised scars – (hypertrophic scars) that form along a wound and can remain this way for a number of years
    • Excess of scar tissue produced at site of the wound – (keloid scars) where the scar grows beyond the boundaries of the original wound, even after it has healed
    • Pitted scars – (atrophic or ‘ice-pick’ scars) that have a sunken appearance
      Scars caused by the shrinking and tightening of the skin – (contracture scars) usually form after a burn, which can restrict movement.

    Depending on the type and age of a scar, a variety of different treatments may help make them less visible and improve their appearance. Scars are unlikely to disappear completely, although most will gradually fade over time. If scarring is unsightly, uncomfortable or restrictive, treatment options may include:

    • Soft wound covers (silicone gel sheets)
    • Pressure dressings
    • Surgery
      Steroid injections (corticosteroid)
    • Make-up (cosmetic camouflage).

    It is often the case that a combination of treatments can be used. Refashioning or removal of scars/treatment and keloids are restricted to certain patients who meet the eligibility criteria below. This is because the medical and surgical treatment of scars and keloids that does not meet the criteria is considered to be a cosmetic procedure.

    Patient eligibility criteria:

    The patient’s local NHS commissioning organisation will fund this treatment if the patient meets the following criteria:

    • For severe post burn cases or severe traumatic scarring or severe post- surgical scarring; or
    • Revision surgery for scars following complications of surgery, keloid formation or other scar formation will only be funded where there is significant functional deformity or to restore normal function.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    • For more information search for ‘scar treatment’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
  • Port Wine Stains

    What are port wine stains?

    A port wine stain (sometimes called a capillary malformation) is a birthmark caused by abnormal development of blood vessels in the skin. They are usually a flat, red or purple mark on the skin that is present at birth.

    Very occasionally, over time, the port wine stain may become thicker, darken and develop a ‘cobblestone’ appearance with raised bumps and ridges.

    Port wine stain occurs early in pregnancy while the baby is developing in the womb. This change in the gene is not inherited (passed on from one generation to the next) and is not known to be related to anything that happened during pregnancy.

    Port wine stains can appear anywhere on the body, in most cases on one side of the body only, but occasionally on both sides. About 65 per cent of port wine stains are on the head and neck. About three in every 1,000 children has a port wine stain. Girls are twice as likely to have a port wine stain as boys, but we do not know why.

    Port wine stains are clearly noticeable and quite different to other types of birthmark so no special diagnostic tests are usually needed. Generally, port wine stains do not need any special treatment.

    However, they do need protection from the sun. The patient should use a high factor sun cream on all areas of exposed skin, and use a hat to protect the patient’s face and/or an umbrella over the buggy or pushchair.

    Port wine stains involving the upper part of the face can be linked to the following conditions:

    Glaucoma: Patients with a port wine stain around the eye have an increased risk of glaucoma. Glaucoma is raised pressure within the eye, which can lead to blindness if it is not treated. Treatment is usually by eye drops and occasionally an operation. A specialist eye doctor (ophthalmologist) should examine the patient’s eyes to check for glaucoma.

    When comparing to the normal eye, the eye on the port wine side may look different. If the pupil looks larger, the eyelids are open further or the eye itself looks larger or more prominent than the other, the patient’s eyes should be checked by a specialist eye doctor.

    Sturge-Weber Syndrome: If the port wine stain is on the skin around the eye, forehead or scalp, there is a chance that the patient may have a condition called Sturge-Weber Syndrome. As well as the port wine stain affecting the skin, it may also involve blood vessels over the surface of the brain, which can cause seizures (fits or convulsions). If there is any suspicion the patient is at risk of Sturge-Weber Syndrome, they will need to be reviewed by a neurologist.

    Klippel Trenaunay Syndrome: A large port wine stain on the arm or leg might be associated with extra growth of that limb and is referred to as Klippel Trenaunay syndrome. This may need a multidisciplinary review by dermatologists, and general, orthopaedic and vascular surgeons.

    Patient eligibility criteria

    There are two options for treatment of port wine stain:

    • Camouflage makeup
    • Laser treatment.

    Camouflage makeup

    Skin camouflage products effectively cover the affected area. Support charity, Changing Faces, provides education by trained volunteer practitioners on the use and application of cosmetic camouflage creams and powders, and people may self-refer. The patient’s GP can prescribe camouflage makeup for patients.

    Cosmetic camouflage creams can be used on any part of the body. The aim is to provide natural-looking cover. They are waterproof, and may remain on the body for up to four days, and on the face for 12-18 hours. Three brands of camouflage product, in a range of shades, are included in the Birmingham, Sandwell and Solihull APC Formulary, and the prescription must be endorsed ‘ACBS’.

    • Covermark classic foundation (10 shades) and Covermark finishing powder
    • Dermacolor camouflage cream (100 shades) and Dermacolor fixing powder
    • Keromask masking cream (9 shades) and Keromask finishing powder.

    Laser treatment

    Laser treatment for a port wine stain, may lighten the affected area of skin. The pulse dye laser is generally considered safe, although long term outcomes are not well studied. The laser passes through a fibre optic cable. On the end of the cable is a device that looks like a pen.

    It’s gently held against the surface of the skin and a button is pressed, which sends a beam of light to the skin. Short term adverse effects are common which vary from pain, skin crusting, bruising and blistering. How effective the treatment is will depend on how prominent and dark the affected area is. The best results are often seen in marks that are already smaller and lighter.

    Patients with port wine stains involving the upper part of the face should be appropriately referred for further investigation to ensure complications of port wine stain, as outlined above, are identified and managed appropriately.

    Laser treatment is not usually funded by your local NHS commissioning organisation for the treatment of port wine stains.

    This is because there is insufficient clinical evidence to support the use of laser treatment as an effective intervention for port wine stain, further research is warranted, particularly around long term outcomes, quality of life and cost effectiveness. This means that the CCG will ONLY fund the treatment if an Individual Funding Request (IFR) application proves exceptional clinical need and this is supported by the CCG.

    Advice and guidance

    • For more information, search for ‘birthmarks’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

    Details of the nearest skin camouflage service can be found at www.changingfaces.org.uk or visit www.birthmarksupportgroup.org.uk and www.skin-camouflage.net 

  • Removal of lipomata

    What are lipomata?

    Lipomata are slow-growing, non-cancerous, fatty tissue (tumours) underneath the skin. Lipomatas may be seen in all age groups, but usually first appear between 40 and 60 years of age. They are common around the tummy, back and shoulder area, but are not found on the hands or feet.

    Often lipomata are removed for purely cosmetic reasons (not routinely funded by the patient's local NHS commissioning organisation), although sometimes patients with multiple lipomata may need a medical procedure that involves taking a small sample of body tissue so it can be examined under a microscope (biopsy) to exclude genetic conditions that cause tumours to grow along the nerves (neurofibromatosis).

    Patient eligibility criteria:

    Removal or treatment of lipomata are not routinely funded by the patient's local NHS commissioning organisation. This is because all removal of lipomata that does not meet the patient eligibility criteria is considered to be a cosmetic procedure.
    The patient's local NHS commissioning organisations will only fund this treatment if the lipomatas are on the face and neck and patient meets the following criteria:

    • Suspected or proven cancerous (malignancy); or
    • Significant functional impairment caused by the lipomata; or
    • To provide evidence in conditions where there are multiple under the skin (subcutaneous) lesions.

    Lipomatas on any other areas of the body should be discussed with GP for care to be agreed locally. For the purposes of the eligibility criteria, functional impairment is classed as a reduction in the ability to carry out an activity of daily living, e.g. the location of the lesion causes reduced movement resulting in interference with sleeping, eating, or walking.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    Lipomata can be left alone as the size usually stabilises after initial growth. If it is necessary to remove the lipomata, they can usually be removed with a simple procedure because lipomatas generally do not infiltrate into surrounding tissue.

    Small lipomatas can be removed, with local anaesthetic used to numb the area. The doctor will cut the skin over the lump and remove the lipomata, before closing the wound with stitches. After the wound has healed, the patient will be left with a thin scar.

    • For more information search for ‘lipomata’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
  • Removal of skin lesions

    What are non-cancerous skin lesions?

    Non-cancerous (benign) skin lesion can include the following:

    • Moles, corns/callous, skin tags (including anal tags)
    • A collection of small white spots commonly known as milk spots (milia)
    • A viral skin infection that most commonly affects children (molluscum contagiosum) A common, harmless condition where the skin becomes rough and bumpy (seborrhoeic keratosis)
    • Swollen blood vessels found slightly beneath the skin surface (spider angioma)
    • Yellowish deposits of fat underneath the skin, usually on or around the eyelids (xanthelasma)
    • Non-cancerous tumours which grow on nerves throughout the body (neurofibromata)
    • Cysts warts (epidermoid/pilar)
    • Skin-coloured, small bumps (papules) frequently found on the forehead and chin of those with acne (comedones).

    Patient eligibility criteria:

    Removal or treatment of non-cancerous skin lesions are not routinely funded by the patient's local NHS commissioning organisation. This is because all removal of these skin lesions, that do not meet the patient criteria are considered to be a cosmetic procedure.

    The patient's local commissioning organisation will only fund the removal of non-cancerous skin lesions if the patient meets the following criteria:

    • Suspected or proven cancer
    • The location of the lesion is causing loss of function
    • Lesion is causing obstruction of orifice or vision (for guidance on clinical criteria please refer to the treatment policy information for upper and lower eyelid surgery)
    • The cyst has been a persistently infected (‘persistent’ is defined as three months) and;
    • The cyst has not responded to anti-biotics over the 3 month period and;
    • The cyst is beyond the scope of primary care to remove and;
    • The cyst is causing a functional impairment.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    Additional information is available at the British Association of Dermatologists website, by searching for ‘patient information leaflets’ on the British Association of Dermatologists website.

    • For more information, search for 'skin lesions' at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
  • Tattoo removal

    What is tattoo removal?

    Tattoo removal or fading involves using a laser to target tattoo ink in the skin. The laser heats the ink particles, so they break up and allow the body to absorb them.

    The amount of treatment needed varies, depending on the individual tattoo. However, it can take up to 12 sessions to treat a professional tattoo, which usually takes place once every eight weeks. The results can vary, depending on the individual tattoo and the type or colour of ink used. Indian ink tattoos are usually easier to treat, and black and red inks tend to fade better. Some inks do not respond to treatment at all.

    Not normally funded treatment or procedure:

    Tattoo removals are not usually funded by the patient’s local NHS commissioning organisation. This is because surgical treatment for removal of tattoos/surgical correction of body piercings is considered to be a cosmetic procedure.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation.

    See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    • For more information search for ‘tattoo removal’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
  • Thigh, buttock and arm lifts (removal of redundant skin or fat)

    What are thigh, buttock and arm lifts?

    Thigh, buttock and arm lifts reshape the area to improve body contours. This is a surgical procedure, removing loose skin or excess fat.

    Not normally funded treatment or procedure:

    Thigh, buttock and arm lifts are not usually funded by the patient’s local NHS commissioning organisation. This is because thigh, buttock and arm lift, removal of redundant skin or fat is deemed to be a cosmetic procedure.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    • For more information search ‘cosmetic procedures’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
  • Thread or spider veins

    What are thread or spider veins?

    Thread veins, also called spider veins, are tiny prominent veins just below the skin surface. They tend to branch and give a spidery sort of pattern, hence their common name.

    Thread or spider veins can occur anywhere on the body but most often on the legs and face. The cause of spider veins is not known. Thread or spider veins may appear in certain conditions with increased levels of oestrogen hormones, such as in pregnancy or when taking the oral contraceptive pill. They may occasionally be linked to liver or thyroid disease. They can develop at any age, but are more common in children.

    Not normally funded treatment or procedure:

    Treatment for thread or spider veins is not normally funded by the NHS as the treatment is considered to be a cosmetic procedure. This is because:

    • In children and some adults, thread veins may go away on their own, which can take several years. Treatment is usually not necessary.
    • Thread veins are related to increased oestrogen hormones, and the levels then go back to normal (after a pregnancy or on stopping an oral contraceptive pill), the thread veins may go away within about nine months.
    • Thread veins can also completely disappear after treatment, but sometimes repeated treatments may be required. The problem may come back a few months later after treatment.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation.

    See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

  • Viral warts

    What are viral warts?

    Viral warts (plantar warts) are small lumps that often develop on the skin of the hands and feet. They vary in appearance and may develop singly or in clusters. Some are more likely to affect particular areas of the body. For example, verrucas are viral warts that usually develop on the soles of the feet. 

    Viral warts are non-cancerous, but can resemble certain cancers. Treatment for viral warts is restricted to patients who meet the minimum eligibility criteria below. This is because most viral warts can be managed with over-the-counter treatments, such as ointments or gel, or by treatments prescribed by the patient's family doctor.

    Treatment for viral warts that does not meet the patient eligibility criteria below is deemed to be a cosmetic procedure.

    Patient eligibility criteria:

    The patient's local NHS commissioning organisation will only fund this treatment if the patient meets the following criteria below:

    • Ano-genital warts that have failed treatment within general practice setting or Genito-Urinary Medicine (GUM) clinic.

    Treatment options include:

    • Salicylic acid paints/gels available in different strengths. Salicylic acid works by removing the outer dead layers of skin and triggering the immune system into clearing the virus
    • Freezing warts (cryotherapy) with a very cold gas (liquid nitrogen) which is available from the patient's GP or pharmacy
    • Chemical paint (contact immunotherapy) which causes an allergic skin reaction that may boost the body’s immune reaction against the viral wart virus.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    • For more information visit the British Association of Dermatologists website and search for ‘plantar warts’ under the patient information leaflets, and at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

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