Pharmacy Unscripted - Managing common skin conditions

Question 1

What does skin provide?

Answer 1

Skin provides a protective barrier against environmental factors as well as allergens and hazardous substances.

Question 2

What else does skin play an important role in?

Answer 2

It plays an important role in regulating body temperature, helping to prevent dehydration and protecting the body from the effects of too much heat or cold. Skin also acts as a sensory organ, allowing the body to feel sensations such as heat, cold, pressure, itching and pain.

Question 3

In the winter months, how does the weather affect the skin?

Answer 3

In the winter months, cold, dry and windy weather can cause water to evaporate from the skin, making it dehydrated. This may be further aggravated by central heating, causing symptoms of eczema and psoriasis to worsen

Question 4

How does hot and humid weather affect the skin?

Answer 4

Skin conditions, such as eczema and rosacea, can also flare up when exposed to hot and humid weather. Additionally, this type of weather can lead to pores being clogged, causing acne.

Question 5

What type of eczema is the most common?

Answer 5

Atopic eczema is the most common form of eczema, a condition that causes the skin to become itchy, dry, cracked and sore. Some people only have small patches of dry skin, while others may have inflamed skin all over the body.

Question 6

Which part of the body does atopic eczema affect?

Answer 6

Atopic eczema can affect any part of the body, but most often affects the hands, inside the elbows, backs of knees and the face and scalp in children.

Question 7

What does inflamed skin appear like on pale vs dark skin?

Answer 7

Inflamed skin can appear red on pale skin, and darker brown, purple or grey on darker skin; it can be more difficult to see on darker skin.

Question 8

What can be used to prevent the skin becoming dry?

Answer 8

emollients

Question 9

What percent of people are affected by Psoriasis?

Answer 9

affects around 2% of people in the UK

Question 10

What age can psoriasis start?

Answer 10

It can start at any age but most often develops in adults under 35 years.

Question 11

What does psoriasis cause?

Answer 11

Psoriasis causes red, flaky, crusty patches of skin covered with silvery scales. These patches usually appear on the elbows, knees, scalp and lower back, but can appear anywhere on the body.

Question 12

What do people with psoriasis have an increased production of?

Answer 12

People with psoriasis have an increased production of skin cells; skin cells are normally made and replaced every three to four weeks, but when a person has psoriasis, this process takes only three to seven days. The build-up of skin cells is what creates the patches associated with psoriasis.

Question 13

What is Psoriasis skin cell turnover thought to be related to?

Answer 13

The process is thought to be related to the immune system.

Question 14

Is there a cure for psoriasis?

Answer 14

There is no cure for psoriasis. However, there are treatments that can usually help keep symptoms under control.

Question 15

What type of treatments can be used for psoriasis?

Answer 15

• Topical – creams and ointments applied to the skin
• Phototherapy – the skin is exposed to certain types of UV light
• Systemic – oral and injected medicines that work throughout the entire body

Question 16

What part of body does rosacea affect?

Answer 16

Rosacea is a skin condition that mainly affects the face.

Question 17

Is rosacea more common in male or females?

Answer 17

t is more common in women (although symptoms can be worse in men) and people with paler skin.

Question 18

What are the symptoms of rosacea?

Answer 18

The symptoms of rosacea include redness across the nose, cheeks, forehead and chin that comes and goes, and a burning or stinging sensation when using water or skincare products.

Question 19

Can Rosacea be cured?

Answer 19

No, but treatment prescribed by a GP can help keep symptoms under control.

Question 20

What are some things patients with rosacea can do without prescription medications?

Answer 20

Using a high SPF sunscreen of at least SPF30 every day
Trying to avoid heat, sunlight or humid conditions if possible
Trying to cover the face in cold weather
Using gentle skincare products for sensitive skin.

Question 21

What can increase handwashing due to COVID-19 cause?

Answer 21

Increased handwashing due to COVID-19 can make hand eczema worse, so advise customers to moisturise their hands after washing and carry a pocket-sized tube of emollient to enable application throughout the day.

Question 22

Approximately, how many days does it take for the epidermis (top layer of the skin) to turn over?

Answer 22

It takes approximately 30 days for the epidermis (top layer of skin) to turn over once and up to three months for the full benefit of any products to be seen.

Question 23

How long should customers be encouraged to continue any treatment or regime for?

Answer 23

For three months to see the full benefit.

Question 24

Can eczema be cured?

Answer 24

Unfortunately, eczema cannot be cured and treatment focuses on managing flare ups by using emollients.

Question 25

For eczema what advice can you give?

Answer 25

Customers should be encouraged to apply emollients at least three times a day and to use the greasiest, non-perfumed formulation that they are happy to use. Customers may use a number of different formulations depending on body area, e.g. greasy ointments on non-visible body parts, creams on arms and legs and lotions on the face.

Question 26

What should people with eczema avoid using?

Answer 26

should avoid using soap and shower gel and use either an emollient as a soap substitute or a specially formulated product. It is no longer recommended that aqueous cream be used for this purpose.

Question 27

What can flare ups of eczema be managed using?

Answer 27

Flare ups of eczema can be managed using corticosteroid creams. Mild steroids such as hydrocortisone and clobetasone are available over the counter (not suitable for use on the face or genitals) and stronger products are available on prescription.

Question 28

After using mild corticosteroids, when should patients be referred to their GP?

Answer 28

Should refer customers to their GP if mild corticosteroids are unsuitable or have not controlled the flare up after seven days, or if there is a possibility that the eczema is infected. You should also encourage people who struggle to sleep or are experiencing psychological effects to speak to their GP.

Question 29

What units should steroid creams be applied in?

Answer 29

Steroid creams should be applied in “fingertip units”.

Question 30

How much is one fingertip unit (FTU)?

Answer 30

One fingertip unit or FTU (steroid squeezed from the tube to cover the length of the index fingertip – about 1 inch) is sufficient to cover the same area of skin as two hands laid flat with the fingers together.

Question 31

After bath/ showering how should the skin be dried for people prone to eczema?

Answer 31

pat the skin dry rather than rubbing

Question 32

How should emollients be applied to the skin?

Answer 32

Wash hands before applying to avoid contamination then Smooth emollients onto the skin in a gentle downward motion in the direction of hair growth

Question 33

Can steroid creams and emollients be used together?

Answer 33

If using a steroid cream, wait at least 30 minutes after applying an emollient before applying the steroid cream

Question 34

Acne can be classed into which three categories?

Answer 34

Mild, moderate and severe

Question 35

What does mild acne present as?

Answer 35

Mild – mostly whiteheads and blackheads, with a few papules and pustules.

Question 36

What does moderate acne present as?

Answer 36

Moderate – more widespread whiteheads and blackheads, with many papules and pustules

Question 37

What does severe acne present as?

Answer 37

Severe – lots of large, painful papules, pustules, nodules or cysts; customers might also have some scarring.

Question 38

What can mild acne be treated using?

Answer 38

using creams and gels containing benzoyl peroxide or nicotinamide that are available over the counter.

Question 39

How does benzoyl peroxide work?

Answer 39

Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin. It also helps to reduce the number of whiteheads and blackheads, and has an anti-inflammatory effect. However, it can be quite irritating to the skin, causing redness, peeling and dryness.

Question 40

How does nicotinamide work?

Answer 40

Nicotinamide is an anti-inflammatory that works to reduce the swelling and redness associated with acne. It also works to regulate the amount of sebum produced.

Question 41

Can patients who present with moderate to severe acne be treated OTC?

Answer 41

No, customers with moderate or severe acne should be referred to their GP.

Question 42

Is acne caused by poor hygiene?

Answer 42

Acne is not caused by poor hygiene but customers should be advised to keep their skin clean by removing make-up with a gentle cleanser and washing twice daily with water and/or an oil-free soap substitute.

Question 43

What can you recommend patient to do that are on acne treatment?

Answer 43

Acne treatments can be drying, so recommend that customers continue to moisturise.

Question 44

What is non-comedogenic?

Answer 44

(doesn’t clog the pores

Question 45

Other than drying side effects, what else can a lot of acne treatments cause?

Answer 45

A number of acne treatments can cause photosensitivity (increased sensitivity to UV light). Customers should be encouraged to use a broad spectrum sunscreen of at least SPF 30 every day, even when cloudy. They should look for non-comedogenic sunscreens which won’t block the pores.