Symptoms In The Pharmacy - Skin Flashcards
What skin conditions can be treated in the pharmacy?
*acne
*chickenpox
*ingrowing toenail
*nappy rash
*athletes foot
*cold sores
*intertrigo/ringworm
*verruca
*dermatitis (acute)
*scabies
What is atopic eczema?
Chronic, itchy skin condition – common
in children
Often accompanies other “atopic” conditions
Rash is dry, flaky and inflamed
Aetiology unclear – trigger factors
What is contact dermatitis?
Commonly on the hands
Consider patient history and occupation
Nappy rash is a type of contact dermatitis
What can be used to treat eczema and contact dermatitis?
Emollients are the mainstay of treatment – they soothe
the skin and can form a waterproof barrier to prevent drying
May be applied to soothe the skin or used as soaps or bath
additives
Topical corticosteroids, e.g. hydrocortisone 1%
w/v, are available as P medicines.
More potent corticosteroids are also available
Antipruritics to prevent itching are also available but generally not
recommended (Doxepin Cream is POM)
When to refer someone with eczema + contact dermatitis?
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
What is seborrhoeic dermatitis?
Affects the sebaceous gland-rich regions of
the 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 typically
do not itch
May be referred to as “cradle cap” in babies
What can be used to treat seborrhoeic dermatitis?
- Treatment may involve the use of keratolytics such as
salicylic acid - Antifungals may also be required
- For infants: mild shampoos +/- baby oil
What is Psoriasis?
- A skin condition sometimes confused
with eczema - Characterised by inflamed skin topped
with silver or white “plaques” - Cause unclear but immune system
believed to be involved
What can be used to treat psoriasis?
- Mild psoriasis typically treated with
topical agents:
Emollients
Coal tar preparations
Dithranol and salicylic acid
Topical corticosteroids - Phototherapy an option for treatment
What are some fungal skin conditions?
*ringworm, spread person-person or animal contact (scalp is rare + to be referred)
*fungal nail infections should be referred as system antibiotics usually required
*athletes foot spread person-person contact or from shared towels in changing rooms
What is used to treat fungal skin infections?
- Ringworm and athlete’s foot can be treated OTC with
topical antifungals - Imidazoles, e.g. miconazole cream (Daktarin®), are the
usual first line treatment for ringworm and are also used for
athlete’s foot - Itraconazole and terbinafine (an allylamine) are also used
OTC in athlete’s foot treatment - Powder and spray formulations are commonly used for
athlete’s foot
When to refer fungal skin infections?
Treatment failure (>2 weeks)
Bacterial infection
Diabetic patients
Involvement of the nail
What is herpes?
- Herpes simplex labialis or cold sores
can usually be managed OTC (viral infection) - Skin infection – usually around lips /
nose caused by the herpes simplex
virus (HSV-1 in most cases or HSV-2)
*HSV2 - genital usually
What triggers herpes?
*sunlight
*other infections (colds/flu)
*menstrual cycle
What is used to treat herpes?
OTC with acyclovir 5% cream (apply 5x5+5)
When to refer someone with herpes?
*eyes/genital regions affected
*age of patient
*painless, in the mouth or lasting >2 weeks
*immunocompromised
What is a wart/verruca?
- Small growths on the skin caused by human papillomavirus (HPV)
- Peak incidence in secondary school children
- A verruca (plantar wart) is just a wart on
the plantar region, i.e. sole of foot - Warts / verrucae contain a network of
capillaries
WILL RESOLVE WITHOUT TREATMENT
What can be used to treat warts + verrucae?
Treatment options typically use 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
When to refer someone with a wart/verrucae?
*suspicious changes in shape or colour + bleeding + itching
*asymmetrical - melanomas usually irregular shape
*border - melanoma border often ragged
*colours - at least 2 colours
*diameter - most melanomas >6mm in diameter
*evolving - moles that change size may be melanoma
*diabetic and immunocompromised patients
*anogential warts in children
*failed treatment
What is acne?
*acne vulgaris = common acne
*hair follicles and sebaceous glands become blocked
*common in teens and largely affects face but back and chest are also common
*mild, moderate or severe
What are ways to treat acne?
Mild to moderate acne can be managed without referral
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
When to refer someone with acne?
Severe acne
Treatment failure
Suspected ADR
ABCDE concerns
Causing mental health issues
What is scabies?
- Scabies is an intensely itchy skin condition caused by a mite
that burrows through the skin rash - Burrows are often seen on the palms
of the hands but rash and itching can
be at other sites - Passed on through close personal
contact – common in schools,
universities, care homes - Can be up to 2 months before symptoms start to appear
What is used to treat scabies?
- two applications of a topical acaricide required 7 days apart
*must be left on for 12-24hrs depending on acaricide used
*other household members should be treated at same time
*treatment can worsen itch initially
When to refer someone with scabies?
*age: young children + elderly
*outbreaks suspected
*crusted scabies (hyper-infection with mites)
*infected rash
*treatment failure
*acquired through sexual activity
What are some examples of communicable diseases?
*measles
*rubella
*chickenpox
*shingles
What are some red flag skin diseases?
*skin cancer (ABCDE)
*meningitis - petechial rash
*erythroderma (>90% of skin affected)
*bullous disorders
*suspected ADR
