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Tackling skin problems in pharmacy

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Tackling skin problems in pharmacy

Skin infections are the most frequent skin complaints that GPs are consulted about. Yet many of these infections can be treated effectively with products available over-the-counter in the pharmacy. 

Fungal skin infections are particularly common and, although they can be troublesome, many can be treated effectively with over-the-counter products coupled with sound advice from pharmacy support staff.

Dermatophyte infections

Dermatophyte infections (also know as tinea infections) cause three common conditions: athlete’s foot, ringworm (a fungal infection of the body) and fungal groin infection. These can be persistent, and indeed annoying for sufferers, but they do only involve the upper layers of the skin. Fungal skin infections are contagious and spread readily by contact, but they are not serious. The same organisms can also cause deep-seated infections of the scalp or hands and these will need prescription treatments.

Athlete’s foot

Athlete’s foot is the most common tinea infection – it affects about 15 per cent of people in the UK. It usually starts with itchy, soggy skin between the toes, especially between the fourth and fifth toes. The skin in this area often looks white and can split as a result of scratching – people will often complain of intolerable itching. The skin over the toe surface can also be affected. A long-standing infection on the sole of the foot often appears as fine, dry, powdery scaling.

Athlete’s foot is often picked up in gyms, swimming pools or at home by direct contact with infected skin scales. This can happen by walking around barefoot or by sharing a towel with someone who has a fungal skin infection. The condition is made worse by things that keep the feet warm and moist, such as wearing rubber boots or trainers or living in warm, humid conditions.

It is important to treat athlete’s foot for two reasons. First, it can spread to other areas of the body and infect the skin on the trunk or in the groin (for example, by using the same towel to dry the feet and then the rest of the body) or it can infect the toenails. Second, the very fact that the skin is broken on the feet can allow other microorganisms to enter the body (e.g. the bacteria that can cause cellulitis).

Dhobie itch

Fungal infection of the groin (also known as ‘jock itch’, ‘gym itch’ or ‘Dhobie itch’) affects men more commonly than women. It causes an area of inflammation involving the upper, inner thighs and anal region. The rash is redder at the edges and is usually itchy. The genitals are usually not affected.

Ringworm

Fungal infection of the skin on the body is commonly known as ‘ringworm’, although it has nothing to do with worms. The rash typically appears as a more or less ring-shaped patch in the skin. The edges tend to be redder than the centre of the patch and it can be itchy and scaly.

Treating fungal skin infections

When helping people to choose treatment for fungal skin infections, the main objective is to cure the infection. Fungal skin infections can be treated with topical creams, gels, sprays or powders. There are two types of topical antifungal products – the azoles (clotrimazole, miconazole, ketoconazole, econazole) and terbinafine. Terbinafine acts more quickly than the azoles against dermatophytes, but it is not licensed for use in children. Although overall cure rates are similar, terbinafine takes effect more quickly and requires shorter treatment times. Other types of treatment such as undecenoate and tolnaftate are also available.

The most common problem in the management of athlete’s foot is poor adherence to treatment. The itching and inflammation usually subside after a few days of treatment and so there is less of a reminder to carry on with treatment, but it takes another few days to kill off all of the fungal cells. If this is not done then the infection reappears soon after stopping treatment. Additionally, warm, damp conditions encourage the growth of dermatophytes, so advise customers to take measures to keep the feet and body folds cool and dry to prevent re-infection.

The treatment for dhobie itch and ringworm is broadly similar to athlete’s foot – treatment with azoles or terbinafine. Spray treatments can be useful because they make it easier to apply to hairy areas of the body. Good general hygiene helps to ensure that treatment is effective and the risk of re-infection is minimised.

Top tips

  • Treatments should be applied to clean, dry skin
  • Apply the treatment after a bath or shower so that it will not be washed off after a few hours
  • If a spray treatment is used, it is important to ensure that a sufficient amount is applied and that the areas between the toes are treated.

Candida infections

Infection with yeast – Candida albicans – can occur in warm moist areas of skin – for example, in skin folds of obese people and in the nappy area of babies. (This is the same organism that causes vaginal thrush.) Candidal skin infection appears as a moist, shiny, red, inflamed area in a body fold such as under the breasts, in the armpits or groin. Candidal skin infections can again be treated with azoles or terbinafine. In addition, people should be advised to wash and dry the affected areas carefully and to avoid tight clothing and non-breathable fabrics.

Pityriasis versicolor

Pityriasis versicolor (PV) typically appears as small pink or light brown patches on untanned skin or pale patches on tanned skin. It usually affects the trunk and upper limbs, and young adults are the most commonly affected group. PV is caused by overgrowth of the yeast Malassezia furfur, which is normally present on human skin. It is sometimes mistaken for vitiligo – a condition where there is more extensive loss of skin pigmentation.

It is not known why some people develop PV and others do not, but the main predisposing factor is a warm, humid environment. People with this condition are usually symptom-free but distressed by the skin’s appearance. PV is not considered to be a contagious disease as the causative organism is naturally present on the skin.

PV can be treated with a topical azole antifungal cream or spray. Another way to treat large areas such as the trunk is to apply ketoconazole or selenium sulphide shampoo to wet skin and leave it on for 10 minutes before washing off. This should be repeated daily for 10 days.

PV does not cause scarring or permanent colour changes but it may take several weeks or months for the colour changes to be reversed.

Quick-fire update

Here’s a reminder of some of the other common skin complaints that customers will often seek advice on:

Dry skin is a common problem often related to a weakened or damaged skin barrier. Regular application of emollients can improve skin condition dramatically. Modern emollients contain moisturising agents like urea or glycerin and barrier repair agents such as ceramides. The use of mild, emollient wash products helps to avoid the drying effects of conventional soap or shower gel.

Eczema is a skin disease in which red, itchy, sore, inflamed patches flare up periodically. About 20 per cent of children suffer from eczema, but many grow out of it. The management of eczema depends on the regular use of emollients and intermittent use of corticosteroid cream or ointment to control flare-ups. Since eczema patients need to use emollients every day, it is best for them to try out different brands and formats of emollients to find out which ones suit them best. Unperfumed products are often more suitable because fragrance ingredients can sometimes trigger an eczema flare-up.

People with psoriasis periodically develop red, thickened patches of skin – often on the elbows or shins – which are covered in thick, whitish scales. The patches can crack and bleed, causing discomfort and embarrassment. Emollients can help to keep the skin flexible and topical treatment with corticosteroids and vitamin D (calcipotriol) preparations can be used to control flare-ups. Severe psoriasis is treated by dermatology specialists with ultraviolet light, oral ciclosporin or methotrexate or by injections of monoclonal antibodies.

Acne is a common skin condition that often appears during puberty, but people can suffer well into adulthood. Benzoyl peroxide is often an effective treatment for mild to moderate acne, providing the sufferer continues using it for long enough – at least four to six weeks. Persistence is key.

Scars can take up to two years to mature, flatten and fade. Surgical scars and burn scars can be softened and flattened by the use of silicone sheeting or silicone gel. Silicone sheets are self-adhesive and should be removed and washed every 24 hours. (The material becomes sticky again when it dries; it can be rewashed many times.) Silicone treatment needs to continue for three to six months.

Stretch marks appear when there is damage to the underlying skin tissue – for example, due to rapid expansion during pregnancy. Stretch marks fade over a period of years.

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