This leaflet explains how to take care of your wound(s) when you leave hospital.

Follow-up

You will be given a follow-up appointment on the day of your surgery only if necessary. Otherwise you will be informed about any necessary follow-up later by either telephone call or letter.

The first 24–48 hours after surgery

• If there is a plaster leave it in place and keep the area dry and clean. If the plaster comes loose please re-tape it. If there is an additional "pressure bandage" this can be usually removed within 24 hours. If the dressing is waterproof a brief shower is allowed but not a bath
• It is unlikely that your wound will bleed, but if this happens, don’t panic. If bleeding continues first apply firm pressure with a handkerchief over the wound for 10-15 minutes. If still bleeding apply an ice-pack for 15 minutes to the bandage (frozen peas in a plastic bag are effective and avoid wetting the bandage). In the unlikely event you have uncontrollable bleeding, call the Dermatology DayCare Department during office hours – 0208 321 5544 or your GP or attend the nearest A&E Department
• If you have pain the local anaesthetic will begin to wear off about 60 minutes after the operation. Post-operative pain is usually mild. You may take Paracetamol containing pain killers. Avoid Aspirin (unless taking it in low doses already) as this may promote bleeding
• If you have had sutures, gym or strenuous exercise should be avoided until stitches removed
• Avoid swimming until the wound is healed

48 hours after surgery (curretage only)

• Carefully remove the plaster. If it is very sticky try soaking it or apply hand sanitiser gel to soften it. After the plaster is off you may gently clean the sticky area with lukewarm water but avoid scrubbing or directing powerful shower jets on the area. Small wounds do not need plasters. Keep the area dry
• Repeat this routine every day/other day until the wound has completely healed over
• If you have a scab after curettage DO NOT try to remove it. Keep the area moisturised with e.g. Vaseline which will help to relieve any itching and promote healing

What is normal

• The first couple of days your wound may be tender and may bleed slightly
• There may be swelling and bruising around the wound, especially if near the eyes
• The area around the wound may be numb for many weeks
• You may experience episodic sharp pains as the area heals (but rare)
• The wound line will look dark pink at first and the edges reddened. This will lighten day by day but it may take many months before the wound turns pale
• With dissolving stitches under the skin you may be able to see and feel small bumps under the wound for several months where the knots are located

Seek medical help if:

Bleeding will not stop after applying pressure and ice; you have excessive pain;  you have signs of infection such as raised temperature, redness, swelling or a foul-smelling discharge from the wound.

What is a skin surgery?

Skin surgery is either when a biopsy (sample) or excision (complete removal of a lesion) is performed. Depending which surgery you are having, either a sample of skin or the complete lesion is removed in order to look at it more closely under a microscope. This is done in order to gain additional information about your condition so that a more precise diagnosis may be made and treatment given accordingly.

What will skin surgery involve?

The whole procedure normally takes between 20 and 60 minutes (times can vary). The skin will first be cleaned with an antiseptic solution. The area will then be numbed by an injection of local anaesthetic under the skin, which will sting a little, after which the area of skin becomes numb. This stops any pain, but you may be aware of the sensation of touch or pulling of your skin during the procedure.

A piece of skin, or skin lesion, will be removed and sent to the laboratory for investigation. You will probably also require stitches, which you will need to organise to have removed, either via the practice nurse at your local GP surgery or local walk-in centre. You will be advised of when they should be removed following the procedure.

Are there any special precautions before skin surgery? 

• Your skin lesion will either be biopsied or removed under local anaesthetic. This means that you will not be asleep during the procedure and you will be able to go home afterwards. It is advisable for a friend or relative to collect you in case you feel light-headed or faint. There is usually no reason why you should not take public transport or drive yourself unless the operation is on your leg, arm, hand, foot or around the eye.
• You may eat and drink as normal on the day of the procedure.
• If you are on regular medication, you should take this as usual. Please bring a medication list to your procedure to show the doctor.
• Before the operation please inform the doctor if you have an artificial heart valve, are allergic to local anaesthetics, dressings or antibiotics, are on anti-coagulants or are pregnant.
• Please avoid strenuous exercise until the stitches are removed.
• It is better not to have the procedure within 2 weeks of going on holiday as you may need stitches to be removed.
• No swimming until the sutures are removed and the wound has healed.
• Please do not bring young children. We cannot supervise children during the procedure.
• Please let us know if you are on Warfarin as you will need to organise an INR check 2 days before the procedure and bring that result with you.
• If you have a cardiac device e.g. a pacemaker or defibrillator, please bring documentation with you confirming what type of device you have. 
• Please arrive 20 minutes before your appointment, if you arrive late for your appointment it is likely that you will have to be re-booked

When shall I know the result?

The doctor will advise you. It can take up to 4 weeks for the results to be available.

PLEASE NOTE THAT ANY MINOR OPERATION WILL LEAVE A SCAR

If you are unable to attend your appointment please contact our administrative team:

West Middlesex University Hospital

Dermatology department, Outpatients 3

T: 020 8321 5473 / 5370

Chelsea and Westminster Hospital

Dermatology department, First Floor

T: 020 3315 6666

This may be relevant to you if you take any of the following medications:

Biologic agents, such as: 

• Adalimumab (Humira, Hyrimoz, Idacio)
• Etanercept (Enbrel, Benpali)
• Cetrolizumab (Cimzia)
• Ustekinumab (Stelara)
• Secukinumab (Cosentyx)
• Brodalumab (Kyntheum)
• Ixikizumab (Taltz)
• Guselkumab (Tremfya)
• Tildrakizumab (Ilumetri)
• Rituximab
• Infliximab (Remicade, Remsima)

 Oral immunosuppressive medication, such as:

• Ciclosporin
• Methotrexate
• Mycophenolate mofetil
• Azathioprine
• Fumaric acid esters
• High dose steroids e.g. prednisolone above 30mg daily
• Thalidomide
• Apremilast

Update on COVID-19 vaccination schedules for immunosuppressed patients – timing of third dose 

The UK Health Security Agency (Public Health) have further updated advice for people who have a severely weakened immune system in relation to third dose and booster vaccination, they should now come forward for a third dose of coronavirus (COVID-19) vaccine. This is to help improve any protection you may have built from your first 2 doses.

What is Coronavirus or COVID-19?

COVID-19 is a very infectious respiratory disease caused by the SARS-CoV-2 virus. It can be very serious in people who have a weakened immune system. There is no cure for COVID-19 although some newly tested treatments help to reduce the risk of complications.

Why are you being offered a third dose of the COVID-19 vaccine?

This third dose is being offered to all those aged 12 years and older who had a weakened immune system when they had their first 2 doses of the COVID-19 vaccine. It is possible you may not have responded as well as other people. This third dose may help to improve your immune response and give you better protection.

Your specialist has advised that this applies to you. By having the third dose you may reduce your chance of catching the COVID-19 infection. And, if you do, the symptoms may be less severe and the illness shorter, than if you had not had the third vaccination.

People who need a third dose are those who had a severely weakened immune system around the time they had their first 2 doses. This includes those who had or have:

• blood cancers (such as leukaemia or lymphoma)
• lowered immunity due to treatment (such as steroid medication, biological therapy, chemotherapy or radiotherapy)
• lowered immunity due to inherited disorders of the immune system
• an organ or bone marrow transplant
• diseases that affect the immune system such as poorly controlled HIV
• other diseases or treatments as advised by your specialist

Timing of third dose and booster

You will need 1 extra dose to improve your protection.

Your extra (third) dose should be given at least 8 weeks after your second dose. After that you will also need a booster dose to extend your protection – this should be given around 3 months after your extra (third) dose.

If you have already had 2 doses and your booster dose then you will need another booster dose 3 months later.

Side effects

Very common side effects include:

• having a painful, heavy feeling and tenderness in the arm where you had your injection. This tends to be worst around 1 to 2 days after the vaccine
• feeling tired
• headache
• general aches, or mild flu like symptoms

You can rest and take paracetamol (follow the dose advice in the packaging) to help make you feel better. Although feeling feverish is not uncommon for 2 to 3 days, a high temperature is unusual and may indicate you have COVID-19 or another infection. Symptoms following vaccination normally last less than a week. If your symptoms seem to get worse or if you are concerned, you can call NHS 111.

How to get the vaccination

Your GP will be in contact with your specialist and the NHS will let you know when and where to have the vaccine.

People who shouldn’t have the third vaccination

If you’ve had a very severe reaction to the previous dose of the vaccine, you should discuss this with your doctor.

If you have missed a vaccination

If you have not yet had either of your first 2 doses of the vaccine you should have them as soon as possible.

If it is now more than 8 weeks from your second dose, please arrange to have your extra (third) dose soon as possible.

You will still need a booster dose, around 3 months after your extra (third) dose. Your specialist should be able to advise on the best timing.

Further information

• COVID-19 vaccination (nhs.uk)  
• An information leaflet on what to expect after vaccination is available to download or order
• If you do develop symptoms of COVID infection and a PCR test is positive you may be eligible for novel treatments which must be given early—find out more