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Applied Pharmacy Practice > Minor Ailments - skin conditions in community pharmacy > Flashcards

Minor Ailments - skin conditions in community pharmacy Flashcards

1
Q

Skin structure
+
dermis function & structure

A
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2
Q

Epidermis structure & function

A
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3
Q

skin facts

A
  • The thickness of the skin is between <0.1 mm – 1.5 mm
  • The skin contributes 15% to total body weight
  • 54% of the UK population will
    experience a skin condition in
    each calendar year
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4
Q

What is dermatology?

A
    • Dermatology = branch of med concerned w/ the diagnosis & treatment of skin conditions.
  • Derma = greek word for skin
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5
Q

Lesion definition

A
  • Single area of abnormal skin
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6
Q

rash definition

A
  • Lesions that are
    widespread
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7
Q

Dermatosis definition

A
  • Disease of the
    skin
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8
Q

Types of lesions

A
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9
Q

What is Acne?

A
  • Caused by increased keratin & sebum production i the skin
  • Results in blockages in hair follicles.
  • Bacteria can get in there as well
  • Inflammatory
  • Causes comedones, papules and pustules
  • Affects the face, chest, upper back
  • Onset at puberty
  • Peaks at 14 – 17 years for girls and 15 – 19 for boys

Comedones = Papule filled with keratin and sebum
Papules = Less than 1 cm in diameter, raised and solid
Pustules = Less than 1 cm in diameter, filled with pus, lasts a few days

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10
Q

Types of severity of Acne

A
If mild or moderate acne is causing psychological upset = classed as severe
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11
Q

How do you treat the diff types of acne severities?

A
  • mild acne= treat OTC initially
  • Moderate & severe acne= Refer to GP
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12
Q

OTC acne treatment = Benzoyl Peroxide

A
  • Reduces bacteria on skin and is anti-inflammatory
  • Reduces comedones
  • Available as 2.5%, 5% and 10% strengths ( * No evidence that higher strength has better efficacy)
  • Cream or gel formulation
  • Apply once or twice daily to parts of skin affected – should work in 6 weeks
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13
Q

Cautions for Benzoyl Peroxide

A
  • Can irritate skin if applied too liberally
  • Can make skin sensitive to the sun
  • Will bleach fabrics – avoid contact with clothing, towels or bedding
  • Side effects include skin feeling dry, burning, itching, stinging, redness or
    peeling
  • Mainly high concentrations
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14
Q

OTC acne treatment = Nicotinamide

A
  • Anti-inflammatory
  • Reduces swelling, redness and tenderness
  • Available as 4% strength
  • Gel formulation
  • Apply twice daily to parts of skin affected for as long as necessary
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15
Q

Cautions for Nicotinamide

A
  • Side effects include dry skin, irritation or peeling
  • Can apply once daily or on alternate days if this occurs
  • Rarely can cause allergic reactions such as itching, redness, swelling or
    burning sensations
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16
Q

What are bites and stings?

A
  • Can be caused by animals or plants
  • 3 types
  • **INSECT STINGS **=
  • Venom is introduced into the body
  • Venom contains proteins and other
    substances that break down cells
  • BITES=
  • Method of breaking the skin to draw blood and secretion of anticoagulant
    substances to help feeding
  • **PLANT STINGS **=
  • Leaf hairs on stinging nettles pierce skin causing release of histamine,
    acetylcholine and serotonin
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17
Q

Bites and stings

A

Insect bites
* Itchy papules, can also cause urticaria and bulla.
Stings
* Intense burning pain, erythema and oedemawhich reduce over a few hours.
* If sting in situ – remove by scraping away
* Do not want to squeeze sting as it might introduce more venom

Papules = Less than 1 cm in diameter, raised and solid
Urticaria = itchy, raised rash caused by reaction
Bulla = Greater than 1 cm in diameter, clear fluid- filled lesion, disappears in less than a week
Erythema = redness of the skin caused by injury or inflammation
Oedema = build-up of fluid

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18
Q

Treatment for bites & stings = Antihistamines

A
  • Histamine is released as a repsonse & can cause swelling
  • Block the effect of histamine in the body
  • Sedating antihistamine e.g. chlorphenamine = piriton
  • Non-sedating antihistamines e.g. cetirizine, loratadine
  • For adults and children (starting ages and doses vary)
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19
Q

Cautions for Antihistamines

A
  • Adverse effects of sedating antihistamines include drowsiness, dry mouth, blurred vision, difficulty passing urine
  • Adverse effects of non-sedating antihistamines include headache, dry mouth, nausea, drowsiness
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20
Q

Treatment for bites & stings = Analgesics

A
  • Typically for wide spread pain
  • Reduces pain
  • Can use paracetamol or ibuprofen = to reduce swelling
  • Ice = reduces swelling
21
Q

Treatment for bites & stings = Hydrocortisone

A
  • v/ localised swelling , 1 or 2 bites
  • Reduces inflammation and swelling
  • Available as 1% strength
  • Cream formulation
  • Apply once or twice daily to parts of skin affected
  • For adults and children over 10-years of age
  • Use for a maximum of 7 days
  • Not licensed OTC to be used on the face
22
Q

Caution for hydrocortisone

A
  • Adverse effects include allergic reactions and blurred vision
23
Q

Treatment for bites & stings = Local anaesthetics

A
  • Reduces pain
  • Savlon Bites and Stings Pain Relief Gel® contains lidocaine
  • Gel formulation
  • Apply three to four times daily
  • For adults and children over 12-years of age
24
Q

caution for Local anaesthetics

A
  • Adverse effects include skin irritation
25
Q

what is pharmacy 1st?

A
  • New scheme started on 1st jan 2024
  • Community pharmacists can supply prescription-only (POM) medicines
  • Seven conditions included in the scheme = Sinusitis, Ear ache , Infected insect bites , Shingles, Sore throat, Impetigo, UTI
  • No need to visit a GP surgery
26
Q

Pharmacy First for infected insect bites

A
  • Supply of POMs for the treatment
    of infected insect bites
  • For adults and children aged 1-
    year and over
  • Flucloxacillin
  • Clarithromycin (or erythromycin if pregnant)
27
Q

when to refer insect bites? - red flags

A
  • Major allergic reaction – call 999
  • Systemic symptoms – refer to GP surgery
  • Tick bites – refer to GP surgery

  • Tick bites cause a rash that radiates out it can appear after 3 nights after the bite has happen
  • Ticks can harbour bacteria that cause Lyme disease.
  • Can case tiredness + muscle & joint pain
28
Q

What are cold sore?

A
  • Small blisters on or around the mouth
  • Usually resolve in 7 – 10 days without treatment
  • Caused by the herpes simplex virus, HSV-1
  • Easily passed from one person to another
  • First symptoms of infection are tingling, itching and burning
  • Causes blisters, vesicles and redness
  • Once it gets into the body it will remain dormant
  • When activated leads to cold sores

Vesicles = Less than 1 cm in diameter, clear, fluid-filled, lasts a few days

29
Q

Treatment for cold sores = Aciclovir

A
  • Reduces duration of symptoms
  • Available as 5% strength
  • Cream formulation
  • Apply five times daily (every four hours) for up to ten days
  • Start as soon as symptoms occur (little benefit if treatment delayed)
  • Speeds up healing time
  • Relieves the tingling itchy sensation
30
Q

When to refer cold sores? / red flags

A
  • Large, painful or recurrent cold sores – refer to GP surgery
  • Babies, pregnant women or
    immunocompromised people – refer to GP surgery
31
Q

What is eczema?

A
  • Eczema and dermatitis often used
    interchangeably
  • Dermatitis = inflammation of the skin
  • Eczema = no clear definition but can mean more acute condition
    Due to external or internal factors
  • External – irritants or allergens= Soaps , makeup, oils
  • Internal – genetic cause = Atopic triad, often those who suffer from atopic conditions, asthma or hay fever will also suffer from eczema.
    Causes:
  • Redness
  • Dry skin
  • Irritation
  • Itching
32
Q

Treatment for eczema = Emollients

A
  • Moisturisers that help hydrate and soothe skin
  • Protect skin and trap moisture in
  • Soothe redness & itchiness
  • Available as creams, gels, lotions, ointments, sprays
  • Apply as often as required, ideally three to four times a day
  • Can also be used to ‘wash’ skin
  • There are no diffenece in the diff types of emollients i.e cream , lotion , gel & ointment all work well. it depends on patient preference
33
Q

Caution for emollients

A
  • Fire – keep away from fire, flames, burning when using emollients + keep bedding you use away
  • Contains flammable agents
  • Infections – use a clean spoon or spatula to take emollients from pots
    or tubs
  • Slipping/falls – emollients can make baths and floors slippery
  • DO NOT USE AQUEOUS CREAM = contains SLS = harmful substance
34
Q

Treatment for eczema = Topical steroids

A
  • Reduce inflammation
  • Available as creams, gels, lotions, mousses, ointments, solutions
  • Potencies vary – mild, moderate, potent, very potent
  • Only mild (hydrocortisone) and moderate (clobetasone) potencies
    available OTC ,others = P ONLY
  • Applied once or twice a day to affected area(s) only, for up to 7 days
  • Wait 20 – 30 minutes between using topical steroids and emollients
35
Q

What are the side- effects of Topical steroids?

A

Common adverse effects:
* Burning or stinging
Less common adverse effects:
* Worsening skin infections
* Skin thinning
* Stretch marks
* Acne
* Rosacea
* Skin colour changes
* Increased hair growth on treated areas

36
Q

How much cream to use?

A
37
Q

When to refer eczema? / red flags

A
  • Fever or systemic symptoms, pustules, weeping or crusting skin – refer to GP surgery = could indicate a bactrial infection - may need antibiotics
  • Rapidly worsening, painful skin with clusters of blisters and punched-out erosions – refer to GP = could indicate herpes simplex infectionn - requires anti-viral treatment
38
Q

What are fungal infections?

A
  • Caused by Candida yeast or dermatophytes (only covering dermatophytes here) = Fungi that get into the epidermis and grow in the keartyoncyte cells.
  • Dermatophytes are fungi that invade the stratum corneum and
    grow in the keratinocytes of the epidermis
  • Can get infections of the hair, nails and skin
  • Dermatophyte infections are highly contagious
39
Q

What are the most likely sites of infection?

A
  • Feet →tinea pedis =(Athlete’s foot)
  • Groin → tinea cruris =(‘Jock’ itch)
  • Ringworm of the skin → =tinea corporis
  • Scalp ringworm → tinea capitis
40
Q

Treatment for fungal infections = Anti-fungal

A
41
Q

When to refer fungal infection? / red flags

A

Scalp ringworm → tinea capitis:
* Systemic treatment required
* Ketoconazole shampoo can be useful adjunct
Ringworm of the skin → tinea corporis:
* Covering a large area, resistant to treatment

42
Q

Fungal nail infections

A
43
Q

Treatment for fungal nail infections = Amorolfine

A
  • Nail lacquer
    • Cut or file down on fungal area and apply nail lacquer
  • Broad-spectrum antifungal
  • Available as 5% nail lacquer
  • Applied weekly until nails return to normal:
  • 6 months for fingernails
  • 9 - 12 months for toenails
    • Licensed for adults as long as they have no more than 2 affected nails
44
Q

When to refer nail infections?/ red flags

A
  • People under 18-years-old
  • People with conditions that make them more susceptible to fungal infections (e.g. diabetic patients and immunocompromised patients)
  • More than two nails affected
  • Treatment failure
45
Q

What are verrucas and warts?

A
  • Affect mainly hands, face, anogenital area and feet
  • Caused by human papilloma virus (HPV)
  • Transmitted by shedded skin or skin-to-skin contact = East to pss from person to person by direct contact to infected skin
  • Virus stimulates basal cell division
  • Resolve spontaneously within 6 months – 2 years
  • Most common in children = have a lot of skin to skin contact
  • Warts – mainly on hands, fingers or knees
  • Verrucas – soles of feet
46
Q

Treatment for verucas & warts = Salicyclic Acid +/- lactic acid

A
  • Breaks down keratin (protein) in skin
  • Available as gel, liquid, paint, plasters
  • Applied to warts or verrucas only
  • Use daily after soaking the skin
  • Each week file off hard skin
  • Can take 12 weeks to work fully
  • Do not apply to unaffected skin as it can have a destructive effect
47
Q

When to refer verucas & warts?

A
  • Anogenital warts
  • Facial warts
  • Patients with diabetes
  • Warts that itch, bleed, grow, change colour
  • Large or painful verrucas -podiatrist can help (cryotherapy = using extreme cold , surgery)
48
Q

Treatment summary = What meds treat the issues?

A

Applied Pharmacy Practice (19 decks)

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