Minor Ailments - skin conditions in community pharmacy Flashcards
Skin structure
+
dermis function & structure
Epidermis structure & function
skin facts
- 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
What is dermatology?
- Dermatology = branch of med concerned w/ the diagnosis & treatment of skin conditions.
- Derma = greek word for skin
Lesion definition
- Single area of abnormal skin
rash definition
- Lesions that are
widespread
Dermatosis definition
- Disease of the
skin
Types of lesions
What is Acne?
- 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
Types of severity of Acne
How do you treat the diff types of acne severities?
- mild acne= treat OTC initially
- Moderate & severe acne= Refer to GP
OTC acne treatment = Benzoyl Peroxide
- 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
Cautions for Benzoyl Peroxide
- 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
OTC acne treatment = Nicotinamide
- 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
Cautions for Nicotinamide
- 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
What are bites and stings?
- 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
Bites and stings
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
Treatment for bites & stings = Antihistamines
- 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)
Cautions for Antihistamines
- 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
Treatment for bites & stings = Analgesics
- Typically for wide spread pain
- Reduces pain
- Can use paracetamol or ibuprofen = to reduce swelling
- Ice = reduces swelling
Treatment for bites & stings = Hydrocortisone
- 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
Caution for hydrocortisone
- Adverse effects include allergic reactions and blurred vision
Treatment for bites & stings = Local anaesthetics
- 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
caution for Local anaesthetics
- Adverse effects include skin irritation
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
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)
when to refer insect bites? - red flags
- 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
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
Vesicles = Less than 1 cm in diameter, clear, fluid-filled, lasts a few days
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
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
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
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
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
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
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
How much cream to use?
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
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
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
Treatment for fungal infections = Anti-fungal
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
Fungal nail infections
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
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
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
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
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)
Treatment summary = What meds treat the issues?
