Minor Ailments - skin conditions in community pharmacy Flashcards
1
Q
Skin structure
+
dermis function & structure
A
2
Q
Epidermis structure & function
A
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
4
Q
What is dermatology?
A
- Dermatology = branch of med concerned w/ the diagnosis & treatment of skin conditions.
- Derma = greek word for skin
5
Q
Lesion definition
A
- Single area of abnormal skin
6
Q
rash definition
A
- Lesions that are
widespread
7
Q
Dermatosis definition
A
- Disease of the
skin
8
Q
Types of lesions
A
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
10
Q
Types of severity of Acne
A
11
Q
How do you treat the diff types of acne severities?
A
- mild acne= treat OTC initially
- Moderate & severe acne= Refer to GP
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
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
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
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
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
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
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)
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
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
what is pharmacy 1st?
* 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
Pharmacy First for infected insect bites
* 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
when to refer insect bites? - red flags
* Major allergic reaction – call 999
* Systemic symptoms – refer to GP surgery
* Tick bites – refer to GP surgery
## Footnote
* 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
What are cold sore?
* 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
## Footnote
**Vesicles** = Less than 1 cm in diameter, clear, fluid-filled, lasts a few days
29
Treatment for cold sores = Aciclovir
* 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
When to refer cold sores? / red flags
* Large, painful or recurrent cold sores – refer to GP surgery
* Babies, pregnant women or
immunocompromised people – refer to GP surgery
31
What is eczema?
* 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
Treatment for eczema = Emollients
* 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
Caution for emollients
* 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
Treatment for eczema = Topical steroids
* 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
What are the side- effects of Topical steroids?
**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
How much cream to use?
37
When to refer eczema? / red flags
* 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
What are fungal infections?
* 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
What are the most likely sites of infection?
* Feet →tinea pedis =(Athlete’s foot)
* Groin → tinea cruris =(‘Jock’ itch)
* Ringworm of the skin → =tinea corporis
* Scalp ringworm → tinea capitis
40
Treatment for fungal infections = Anti-fungal
41
When to refer fungal infection? / red flags
**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
Fungal nail infections
43
Treatment for fungal nail infections = Amorolfine
* 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
When to refer nail infections?/ red flags
* 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
What are verrucas and warts?
* 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
Treatment for verucas & warts = Salicyclic Acid +/- lactic acid
* 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
When to refer verucas & warts?
* 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
Treatment summary = What meds treat the issues?
