Symptoms in the Pharmacy - Skin Flashcards
What Scheme do we use in Wales?
CAS - Community pharmacy Common Ailment Scheme
[public come into pharmacy and purchase medicines but pharmacy will be re imbursed for it]
What conditions can be treated?
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Ace
Chickenpox
Conjunctivitis
Diarrhoea
Hay-fever
Ingrowing toenail
Nappy rash
Sore throat/tonsilitis
Vaginal thrush
Athletes food
Cold sores
Constipation
Dry Eye
Head lice
Ringworm
Oral thrush
Teething
Verucca
Backache
Colic
dermatitis
Haemorrhoids
Indigestions/reflux
Mouth ulcers
Scabies
Threadworm
Eczema & Dermatitis
Eczema often reserved for atopic eczema and dermatitis for contact dermatitis
Atopic eczema
Chronic, itchy skin condition – common in children
Often accompanies other “atopic” conditions
Rash is dry, flaky and inflamed
Aetiology unclear – trigger factors
Contact dermatitis
Commonly on the hands
Consider patient history and occupation
Nappy rash is a type of contact dermatitis
Eczema & Dermatitis - Treatments
Emollients (1st) – they soothe the skin = form a waterproof barrier to prevent drying
Applied to soothe the skin/ used as soaps or bath additives
Topical corticosteroids, e.g. hydrocortisone 1% w/v, are available as P medicines. More potent corticosteroids avail.
Antipruritics to prevent itching are also available but generally not recommended
When to refer for Eczema?
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
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 of seborrhoeic dermatitis
Presents as scaly patches which typicallydo not itch
M
ay be referred to as “cradle cap” in babies
What treatment can be used to treat Seborrhoeic dermatitis?
keratolytics such as salicylic acid
antifungals can be used
For infants mild shampoos +/- baby oil or olive oil
Psoriasis (do nto confuse with eczema)
observe: inflamed skin toppedwith silver or white “plaques”
Cause unclear but Immune systembelieved to be involved
Mild psoriasis typically treated with topical agents:
Emollients
Coal tar preparations
Dithranol and salicylic acid
Topical corticosteroids
Phototherapy an option for treatment
(bc eczema can get better in the sun normally when exposed to sunlight)
Fungal - Skin infections
Ringworm is a fungal infection thatpresents as a circular rash
Spread by person-person / person-animal contact
Ringworm of the scalp is rare andshould be referred
Fungal nail infections should be referred as system antibiotics usuallyrequired
Athlete’s foot is a fungal foot infectionusually spread by person-person contact or from shared towels, changing rooms etc.
Skin infections (Fungal) – Treatment
OTC with topical antifungals - ringworm and athlete’s foot
e.g. Itraconazole and terbinafine
powder and spray formulations are used
What is the first lie treatment for athlete’s foot adn ringworm?
Imidazoles, e.g. miconazole cream (Daktarin®)
When to refer - fungals
Treatment failure (>2 weeks)
Bacterial infection
Diabetic patients
Involvement of the nail
Herpes - Skin infections
herpes/cold sores = managed OTC
usually around lips /nose caused by the herpes simplexvirus (HSV-1 in most cases)
OTC with aciclovir 5% cream (apply 5 × 5 + 5)
causes cold sores/ herpes; factors =
Sunlight
Other infections (colds / flu)
Menstrual cycle
When to refer - Herpes/ Cold sores?
Eyes / genital regions affected
Age of patient? (Zovirax® cream has no age restrictions)
Painless, in the mouth or lasting >2 weeks
Immunocompromised
Warts & verrucae
Small growths on the skin caused by human papillomavirus (HPV)
verruca (plantar wart) is just a wart on the plantar region, i.e. sole of foot
Warts / verrucae contain a network ofcapillaries
Warts are limiting - but appearance can be distressing for patients
Warts & verrucae – Treatments
Keratolytics =
Salicylic acid based products are commonly used. This active ingredient gradually 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
liquid nitrogen can be used in secondary care by GPs
When to refer - Warts & verrucae
Suspicious changes in shape or colour +/- bleeding and itching
(A) Asymmetrical – melanomas usually irregular shape
(B) Border – melanoma border often “ragged”
(C) Colours – at least 2 colours
(D) Diameter – most melanomas >6mm in diameter
(E) Evolving – moles that change in size may be a melanoma
Diabetic and immunocompromised patients
Anogenital warts in children
Failed treatment
Acne
Acne vulgaris = common acne
Hair follicles and sebaceous glands
High incidence in teenagers and largely affects the face, but back and chest are other common sites
Classified as mild / moderate / severe
Type of spots/ acne, when is it severe?
Closed comedones - white/black heads - MILD
Open comedones - MILD
Nodules - moderate to severe / Acne vulagris
Acne – Treatments
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
NOT to prevent acne but to put on before the nodules strart appearing
When to refer - Acne?
Severe acne
Treatment failure
Suspected ADR
ABCDE concerns
Causing mental health issues
Scabies
intensely itchy skin condition caused by a mite that burrows through the skin > rash
Burrows are often seen on the palmsof the hands but rash and itching canbe at other sites
Passed - close personal contact (schools, care homes)
How much time des symptoms appear - scabies
may take up to 2 months
Scabies - treatments:
Two applications of a topical acaricide required 7 days apart
Must be left on for 12-24 hours depending on the acaricide used
Other household members should be treated at the same time
Treatment can worsen the itch initially
When to refer - scabies?
Age: young children and elderly
Outbreaks suspected, e.g. in a school
Crusted scabies (hyper-infection with mites)
Infected rash
Treatment failure
Acquired through sexual activity?
Communicable diseases
Many (typically childhood) communicable diseases present with skin rashes
Shingles -elderly
If fever and/or malaise then unlikely to be asimple skin condition > consider communicablediseases
Communicable disease - referral?
if suspected bacterial skin infection (paticurlarly diabetic patients, respiratory symptoms)
Measles, chickenpox, herpes Zoster (singles), rubella
What are the red flags - skin
Skin cancer (ABCDE)
Meningitis – petechial rash
Erythroderma (>90% of skin affected)
Bullous disorders
Suspected ADR
