Symptoms In The Pharmacy - Skin

• What skin conditions can be treated in the pharmacy?

  *acne*chickenpox*ingrowing toenail*nappy rash*athletes foot *cold sores*intertrigo/ringworm*verruca*dermatitis (acute)*scabies
• What is atopic eczema?

   Chronic, itchy skin condition – commonin children Often accompanies other “atopic” conditions Rash is dry, flaky and inflamed Aetiology unclear – trigger factors
• What is contact dermatitis?

   Commonly on the hands Consider patient history and occupation Nappy rash is a type of contact dermatitis
• What can be used to treat eczema and contact dermatitis?

   Emollients are the mainstay of treatment – they soothethe skin and can form a waterproof barrier to prevent drying May be applied to soothe the skin or used as soaps or bathadditives Topical corticosteroids, e.g. hydrocortisone 1%w/v, are available as P medicines.More potent corticosteroids are also available Antipruritics to prevent itching are also available but generally notrecommended (Doxepin Cream is POM)
• When to refer someone with eczema + contact dermatitis?

   Infected rashes, e.g. weeping from the rash Suspected ADR or unidentifiable cause Failed medication, e.g. >1 week of topical corticosteroid use Always consider meningitis / septicaemia
• What is seborrhoeic dermatitis?

   Affects the sebaceous gland-rich regions ofthe skin, e.g. scalp Can also occur at other hairy sites,e.g. under arms, chest Dandruff is an (uninflamed) form ofseborrhoeic dermatitis Presents as scaly patches which typicallydo not itch May be referred to as “cradle cap” in babies
• What can be used to treat seborrhoeic dermatitis?

  • Treatment may involve the use of keratolytics such salicylic acid
  • Antifungals may also be required
  • For infants: mild shampoos +/- baby oil
• What is Psoriasis?

  • A skin condition sometimes confusedwith eczema
  • Characterised by inflamed skin toppedwith silver or white “plaques”
  • Cause unclear but immune systembelieved to be involved
• What can be used to treat psoriasis?

  • Mild psoriasis typically treated withtopical agents: Emollients Coal tar preparations Dithranol and salicylic acid Topical corticosteroids
  • Phototherapy an option for treatment
• What are some fungal skin conditions?

  *ringworm, spread person-person or animal contact (scalp is rare + to be referred)*fungal nail infections should be referred as system antibiotics usually required*athletes foot spread person-person contact or from shared towels in changing rooms
• What is used to treat fungal skin infections?

  • Ringworm and athlete’s foot can be treated OTC withtopical antifungals
  • Imidazoles, e.g. miconazole cream (Daktarin®), are theusual first line treatment for ringworm and are also used forathlete’s foot
  • Itraconazole and terbinafine (an allylamine) are also usedOTC in athlete’s foot treatment
  • Powder and spray formulations are commonly used forathlete’s foot
• When to refer fungal skin infections?

   Treatment failure (>2 weeks) Bacterial infection Diabetic patients Involvement of the nail
• What is herpes?

  • Herpes simplex labialis or cold sorescan usually be managed OTC (viral infection)
  • Skin infection – usually around lips /nose caused by the herpes simplexvirus (HSV-1 in most cases or HSV-2)*HSV2 - genital usually
• What triggers herpes?

  *sunlight*other infections (colds/flu)*menstrual cycle
• What is used to treat herpes?

  OTC with acyclovir 5% cream (apply 5x5+5)
• When to refer someone with herpes?

  *eyes/genital regions affected *age of patient *painless, in the mouth or lasting >2 weeks*immunocompromised
• What is a wart/verruca?

  • Small growths on the skin caused by human papillomavirus (HPV)
  • Peak incidence in secondary school children
  • A verruca (plantar wart) is just a wart onthe plantar region, i.e. sole of foot
  • Warts / verrucae contain a network ofcapillariesWILL RESOLVE WITHOUT TREATMENT
• What can be used to treat warts + verrucae?

  Treatment options typically use keratolytics Salicylic acid based products are commonly used. This active ingredientgradually destroys the affected area Care to ensure that the formulation is only applied to the wart /verruca (protect surrounding skin with white soft paraffin) Emphasise that successful treatment may take >3 months Cryotherapy used to freeze off wart (10-14 days) – home kits available
• When to refer someone with a wart/verrucae?

  *suspicious changes in shape or colour + bleeding + itching*asymmetrical - melanomas usually irregular shape*border - melanoma border often ragged*colours - at least 2 colours*diameter - most melanomas >6mm in diameter *evolving - moles that change size may be melanoma *diabetic and immunocompromised patients*anogential warts in children*failed treatment
• What is acne?

  *acne vulgaris = common acne*hair follicles and sebaceous glands become blocked*common in teens and largely affects face but back and chest are also common *mild, moderate or severe
• What are ways to treat acne?

  Mild to moderate acne can be managed without referral Many OTC products are available Benzoyl peroxide is usually the first line treatment 2.5%, 5% and 10% strengths available – start with lowest Treatment required for at least 6-8 weeks Antibiotics and retinoids are POMs and require referral Sunlight may help, avoid greasy foundation
• When to refer someone with acne?

   Severe acne Treatment failure Suspected ADR ABCDE concerns Causing mental health issues
• What is scabies?

  • Scabies is an intensely itchy skin condition caused by a mitethat burrows through the skin  rash
  • Burrows are often seen on the palmsof the hands but rash and itching canbe at other sites
  • Passed on through close personalcontact – common in schools,universities, care homes
  • Can be up to 2 months before symptoms start to appear
• What is used to treat scabies?

  • two applications of a topical acaricide required 7 days apart*must be left on for 12-24hrs depending on acaricide used*other household members should be treated at same time*treatment can worsen itch initially
• When to refer someone with scabies?

  *age: young children + elderly *outbreaks suspected *crusted scabies (hyper-infection with mites)*infected rash*treatment failure*acquired through sexual activity
• What are some examples of communicable diseases?

  *measles *rubella *chickenpox*shingles
• What are some red flag skin diseases?

  *skin cancer (ABCDE)*meningitis - petechial rash*erythroderma (>90% of skin affected)*bullous disorders *suspected ADR