Section 3 - Adult health checks

Health check recommendations

• All Aboriginal and Torres Strait Islander people > 15 years of age annually
• All people > 15 years of age opportunistically

1. Procedure

• Ask the questions as per Table 1.
• Be prepared to visualise areas by asking the consenting patient to remove parts of their clothing or footwear
• Provide brief intervention if inadequate skin care behaviours are identified
• Determine if the patient requires a referral and place onto a follow-up and recall register

2. Results

• Healthy skin should be clean, slightly oily and intact

3. Brief intervention ^1–5

• Skin protects the body from microbes, bacteria and the elements, helps regulate body temperature and permits the sensations of touch, heat and cold
• Staphylococcus aureusbacteria, found in soil, water, air, the nose and skin:
  • is often superficial and mostly non-life threatening cause of skin infections e.g. boils, cellulitis and impetigo
  • clean any non-infected sores with soap and water and apply a cover
• Group A Streptococcal bacteria that is commonly found in the throat and on skin:
  • can lead to life-threatening acute rheumatic fever (ARF), acute post-streptococcal glomerulonephritis (APSGN) or Heart failure
  • clean any non-infected sores with soap and water and apply a cover
• Parasites that invade the skin include head and pubic lice and scabies can lead to renal complications e.g. Chronic kidney disease:
  • regularly wash and change clothes and bedding
• Mosquitoes, ticks, fleas and other insects can transmit debilitating and sometimes life-threatening parasites e.g. malaria (plasmodium), or viruses e.g. dengue fever and Ross River fever, Japanese Encephalitis:
  • use mosquito coils and skin repellent during evenings. Rid homes and yards of containers of stagnant water. Spray insecticide under and around household items
• Ringworm, tinea, jock rash, thrush and athlete’s foot are common fungal infections
  • keep skin dry, aired and moisture free. change sweaty or damp clothes
• Viral infections are often highly infectious, but mostly harmless and resolve with time. They include:
  • herpes: easily transmitted to mouth or genitalia when kissing or during oral sex when herpes sore is present
  • warts: avoid touching or bathing with others to avoid spreading
  • molluscum contagiosum (multiple watery blisters): usually benign but:
    • seen in warm, humid climates where living conditions are crowded
    • often seen in immunocompromised patients e.g. HIV, during cancer treatment
    • spreads prolifically in children from bathing. Encourage showering only. Cover and avoid contact with others
  • shingles: painful itchy blisters on the face, chest, back, abdomen or pelvis caused by the chickenpox virus. Usually seen in those unvaccinated or immunocompromised and > 40 years
  • encourage vaccination e.g. chicken pox, measles, mumps and rubella, etc.
• Rashes are common and can be caused by viruses (above), allergens or environmental irritants such as:
  • detergents, creams, skin products etc. Trial any change of product
  • pets, cigarette smoke, dust mites, mould, workplace materials, pollens etc.
• Frequent and prolonged exposure to direct sunlight:
  • can lead to skin cancer e.g. basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), including those with dark skin, particularly under the arms and fingers nails and soles of feet
  • in summer, September to February (UV level > 3): limit exposure to before 10am and after 3pm
  • in late autumn and winter, March to August (UV level < 3):  any daytime outdoor activity with skin partly covered most days of the week
  • use wide brim hats, sunglasses and full length clothing over the arms and legs
  • apply a SPF 30+ sunscreen liberally to exposed skin 20 minutes before going outdoors and reapply every 2 hours. See Resource 1.
• Effective hand hygiene is the single most important strategy to prevent most contact related infections and parasites. See Resource 2.

4. Referral

• For multiple presentations of similar skin conditions, be alerted to a broader community public health outbreak e.g. APSGN or ARF. Contact your local Population Health Unit to determine a course of action
• Refer to the Primary Clinical Care Manual or the MO/NP for:
  • any abnormal or unresolving bacterial or fungal infections, rashes or parasites
  • any changes or painful birthmarks, moles, marks, etc.
  • always suspect Rheumatic heart disease,or APSGN in rural and remote locations

5. Follow-up

• Place the person on a recall register if required
• Ensure all referrals are actioned
• Provide the person with details for the next scheduled follow-up appointment

6. References

• All Chronic Conditions Manual references are available via the downloadable References PDF

7. Resources

1. SunSmart resources available from Cancer Council
2. Handwashing resources available from Hand Hygiene Australia