W20 Symptoms in the pharmacy: Skin Flashcards
What are the skin conditions treated under the Community Pharmacy Common Ailments Scheme? (8)
Acne
Nappy rash
Athletes Foot
Cold sores
Intertrigo/ringworm
Verruca
Dermatitis (acute)
Scabies
Eczema & Dermatitis:
When are these terms used?
- These two terms are often used interchangeably
- Eczema often reserved for atopic eczema and dermatitis for contact dermatitis
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 are the treatments for Eczema & Dermatitis? (3)
- 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
When to refer Eczema and 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?
How can it be treated?
− 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
- Treatment may involve the use of keratolytics such as salicylic acid
- Antifungals may also be required
- For infants mild shampoos +/- baby oil or olive oil
What is psoriasis?
What causes it?
- 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
- Non-Caucasians tend to have greater areas of skin affected
How can psoriasis be treated?
- 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 infections?
Ringworm, Fungal nail infections, Athlete’s foot
What is ringworm and ringworm of the scalp?
How is it spread?
Ringworm
-A fungal infection that presents as a circular rash
- Spread by person-person/ person-animal contact
- Ringworm of the scalp is rare and should be referred
Should Fungal nail infections be referred?
Should be referred as system antibiotics usually required
What is Athlete’s foot?
How is it spread?
A fungal foot infection
Usually spread by person-person contact or from shared towels, changing rooms etc.
How is ringworm and athlete’s foot treated?
- 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 Ringworm and Athlete’s foot:
− Treatment failure (>2 weeks)
− Bacterial infection
− Diabetic patients
− Involvement of the nail
What is Herpes?
What is it triggered by? (3)
- Skin infection –usually around lips/nose caused by the herpes simplex virus (HSV-1 in most cases)
− Sunlight
− Other infections (colds / flu)
− Menstrual cycle
How can Cold sores ( aka Herpes simplex labials) be treated?
When to refer to GP? (4)
Treatment OTC with aciclovir 5% cream (apply 5 × 5 +5)
When to refer:
− Eyes / genital regions affected
− Age of patient? (Zovirax® cream has no age restrictions)
− Painless, in the mouth or lasting >2 weeks
− Immunocompromised
What are warts & verrucae?
- 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
- Warts and verruca will eventually resolve without treatment, but the appearance can be distressing for patients
How can warts and verrucae be treated?
How to counsel the patient on applying the treatment:
How to protect the surrounding skin”
- 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 warts and 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
What is Acne?
- Acne vulgaris = common acne
- Hair follicles and sebaceous glands become blocked
- High incidence in teenagers and largely affects the face, but back and chest are other common sites
- Classified as mild / moderate / severe
How is acne treated?
- 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 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
How to treat scabies:
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?
What are Communicable diseases?
Examples?
- Many (typically childhood) communicable
diseases present with skin rashes - Details will not be covered in this lecture
- Shingles more likely in elderly individuals
- If fever and/or malaise then unlikely to be a
simple skin condition →consider communicable
diseases - Referral required if suspected bacterial skin
infection (particularly in diabetic patients, respiratory symptoms
Measles, Chickenpox, Shingles (Herpes Zoster)
What are the Red flags of Communicable diseases?
- Skin cancer (ABCDE)
- Meningitis –petechial rash
- Erythroderma (>90% of skin affected)
- Bullous disorders
- Suspected ADR
Treatment of chicken pox
Antihistamine- Chlorphenamine 2mg/5ml
Possibly Calamine lotion
