9 months ago

2017 HCHB_digital

Acne Acne is a common

Acne Acne is a common skin problem affecting more than 85% of adolescents and is most prevalent in those aged 16 to 18 years. It usually starts between the ages of 12 and 14 due to hormone changes which activate glands in the hair follicles of the skin, causing them to enlarge and produce more sebum (oil) as well as other substances that induce inflammation. Skin pores can become blocked and inflamed resulting in the development of comedones. Comedones are dark or skin-coloured small bumps, better known as blackheads or whiteheads. If the walls of the hair follicle inside the skin pore rupture, a more intense inflammatory response is seen and pustules (also known as spots, pimples or zits) develop. Bacteria within the hair follicle (Propionibacterium acnes) enhance inflammatory lesions. Acne is more common on the face and neck, but can occur on the back, buttocks and chest. It can lead to secondary skin colour changes (red, white and brown patches) and scarring. Acne is due to a combination of factors including a familial tendency (other family members have bad acne), androgenic hormones, acne bacteria, a person's immune response and vulnerability of their hair follicles. Flares of acne can be provoked by high environmental humidity, application of occlusive skin products (especially moisturisers or foundations containing lanolin, petrolatum, vegetable oils, butyl stearate, lauryl alcohol or oleic acid), greasy or waxy hair styling products, pressure from head bands or chin straps, polycystic ovarian disease and diets high in dairy products and high-glycaemic foods. Acne can also be caused by some medicines (eg, oral corticosteroids, contraceptive agents, anticonvulsants) or as a result of occupational exposure to oils, tars or other petrochemical products. In most people, acne will clear up by the age of 25 years, although acne that persists into adulthood is still common, particularly in women. Persistent acne is more likely to cause deep-seated, inflamed pimples and nodules, and may be less responsive to normal treatment. Combination treatment may be needed. Initial assessment Looking at a person's face may give you some idea of the severity of their acne but it is important to ask them if they also have it elsewhere, such as their back or shoulders, and how it impacts on their day-to-day life. Mild acne can be easily treated with topical anti-acne products but refer people with moderate-to-severe acne, acne that affects their self-esteem, or acne unresponsive to over-thecounter treatments to a pharmacist who may suggest further referral to a doctor or skin specialist. Treatment Active ingredients in over-the-counter products available for mild acne may reduce counts of Propionibacterium acnes bacteria, calm red or inflamed skin, contain antioxidants that protect cells from damage, unplug blocked follicles, increase the shedding of dead cells from the surface of the skin, or normalise TREATMENT OPTIONS Category Examples Comments Soap-free face washes Keratolytic + antibacterial action Antibacterial, antiinflammatory or keratolytic action Other [GENERAL SALE] eg, AZClear Action, Benzac range, DermaLab range, Clearasil range, GramaDerm cleanser, OXY Daily Face Wash, No 'Zit' Sherlock [GENERAL SALE] Contains benzoyl or hydrogen peroxide eg, Benzac AC 10%, Crystaderm cream* Contains salicylic acid eg, Clean & Clear, No 'Zit' Sherlock [GENERAL SALE] eg, Epiology Contains phycosaccharide ACP and keratolytics eg, OXY range for men Superoxidised solutions eg, Gramaderm Antiacne Hydrogel [PHARMACY ONLY] Contains azaleic acid eg, AZClear Action, Skinoren [GENERAL SALE] eg, Mebo Acne Clear, Tea Tree, zinc Products with an asterisk have a detailed listing in the Acne section of OTC Products, on page 220. Face washes degrease the skin and help to reduce skin bacteria. Use at least twice daily before applying treatment products for best effect. Some products contain cetrimide or chlorhexidine for their antibacterial action. Others include benzoyl peroxide or salicyclic acid for their keratolytic effect. Phycosaccharide ACP is a naturally sourced ingredient derived from brown seaweed that regulates sebum production, reduces bacterial counts, and has an anti-inflammatory action. Consider as first-line treatment for mild to moderate acne. Some reddening, soreness and worsening of acne may occur initially and a light, non-oily moisturiser may be applied. Discontinue use if skin becomes too reddened, inflamed and sore. Some improvement may be seen in as little as five days but may take several weeks or months to have the maximum effect. Benzoyl peroxide can bleach clothing, bedding and, rarely, hair and eyebrows. Apply to the entire affected area at night and avoid exposure to direct sunlight during treatment. Start with the lowest strength formulation but consider a higher strength if three or four weeks of treatment produces no improvement. Epiology contains an antibacterial agent, IPD, that also calms and soothes skin. Phycosaccharide ACP regulates sebum production, reduces bacterial counts, and has an anti-inflammatory action. Keratolytics remove dead skin and clear clogged pores. Superoxidised solutions are electrochemically processed aqueous solutions made from water and sodium chloride that represent a safe, effective alternative to antibiotics and hydrogen peroxide. Azaleic acid products should be applied to the entire affected area twice daily and rub in well. Avoid contact with the eyes as products will sting. Make-up can be applied over the application. If irritation occurs reduce frequency of application until the skin settles. Can take several weeks for effects to be noticeable. Mebo contains cactus extracts and other ingredients to help fight bacteria and stimulate the natural regrowth of skin tissue. Tea tree and zinc may help support acne-prone skin. End the embarrassment of Adult Acne Page 12 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION skin cell maturation. Treatment is usually effective, although it may take several weeks or months to see a noticeable improvement. Good, consistent, twicedaily skincare underlies treatment success. The face should be cleansed with a mild soap-free cleansing wash prior to applying the treatment product. Some people may be sensitive to treatment products so recommend a customer test the treatment product on a small area of skin when using for the first time. Stronger treatments (eg, antibiotics, hormonal contraceptives, retinoids) are available on prescription. There are also various laser and light therapy treatments for acne. Acne can have a long-lasting effect on a person's self-esteem in addition to causing permanent skin changes such as scarring and discolouration, so finding a treatment that works is very important. Advice for customers • Avoid regular soap as this can be too drying. Instead, use a mild cleansing lotion twice a day and after exercise to gently cleanse the skin. • Apply a thin smear of treatment product to the whole area of affected skin, not just to individual spots or pimples. This is because it can take two to three weeks for the blocked follicle to show on the surface of the skin, so it is important to treat those areas which are still in the process of developing. • Most treatment products cause dryness, particularly in the first month of use. Reassure the customer that this shows the product is working, and the skin usually adjusts to this effect. An oil-free moisturiser may be applied between treatments if the skin is obviously peeling. • Minimise the use of oily substances on the face. Use sunscreens that are noncomedogenic or non-acnegenic and if using foundation, choose an oil-free one specific for acne-prone skin and apply it lightly. • Avoid picking or squeezing acne spots – it can aggravate the inflammation and cause scarring. • Exposure to sunlight filtered through window glass can help, but avoid sunburn. »» Use a sunscreen before going outside. • There is a link between what you eat and acne with research showing high glycaemic diets and dairy can exacerbate acne. Low-glycaemic and low-dairy diets that contain plenty of wholefoods and vegetables may help improve acne. Avoid protein or amino acid supplements, particularly if they contain leucine. • Avoid cigarette smoke – nicotine increases comedone formation. • Don’t be discouraged if one treatment product does not work – there are many different types available and more than one may need to be tried. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment or a caregiver's history may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, immunosuppression, diabetes, is pregnant or breastfeeding)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications) that may be affecting the acne? • Is the customer younger than 12 years or older than 30? • Are there any atypical features? (Some other skin conditions may appear similar to acne but need different treatment.) • Is the acne moderately severe or severe (ie, are there many inflammatory lesions or cysts), or extensive? • If the customer is a woman ask if she also has problems with excessive facial hair, irregular periods and weight gain. • Has previous treatment been unsuccessful despite use for longer than three months? • Could the customer’s acne be the result of their occupation (eg, work involving long-term contact with oils) or does the acne occur after exposure to certain topical products? • Does the customer have sensitive skin or any allergies to topical products? Grown up acne needs a grown up solution Azclear Action Medicated Lotion is an antibacterial lotion for the treatment of blackheads, pimples, acne and papulopustular rosacea. Dual action: Works by fighting bacteria and unblocking the oil ducts, which acts to reduce redness and dry up pimples. Active: Azaleic Acid 20%w/w. Pharmacy Medicine. Dosage and Administration: Apply a small amount to cleansed skin onto the affected skin. Precautions: Avoid eye contact. If no improvement in 8 weeks, consult a healthcare professional. Side Effects: Discontinue use if severe irritation occurs. Douglas Pharmaceuticals, Auckland. TAPSMR5158 Page 13

  • Page 1 and 2: HEALTHCARE HANDBOOK incorporating t
  • Page 3 and 4: 2017-2018 HEALTHCARE HANDBOOK PUBLI
  • Page 5 and 6: Index Common Disorders Acne--------
  • Page 7 and 8: Asthma and COPD CONTINUING OTC EDUC
  • Page 9 and 10: Head and scalp • Condition of hai
  • Page 18 and 19: Allergies An allergy occurs when th
  • Page 20 and 21: Asthma and COPD Asthma New Zealand
  • Page 22 and 23: Baby Feeding Breastfeeding is best
  • Page 24 and 25: Bites and Stings Bites and stings c
  • Page 26 and 27: Bruises, Scars, Spider Veins Bruise
  • Page 28 and 29: Childhood Diseases and Immunisation
  • Page 30 and 31: Childhood Diseases and Immunisation
  • Page 32 and 33: Childhood Diseases and Immunisation
  • Page 34 and 35: Childhood Diseases and Immunisation
  • Page 36 and 37: Childhood Pain and Baby Teething Pa
  • Page 38 and 39: Colds A cold is a contagious viral
  • Page 40 and 41: Cold Sores Cold sores are fluid-fil
  • Page 42 and 43: Constipation Constipation is the te
  • Page 44 and 45: Contraception & Sexual Wellbeing Co
  • Page 46 and 47: Contraception: Emergency Emergency
  • Page 48 and 49: Coughs: Dry Coughs are called dry o
  • Page 50 and 51: Coughs: Productive Coughs are consi
  • Page 52 and 53: Cuts, Abrasions and Blisters This t
  • Page 54 and 55: Cystitis [Bladder Infection] Cystit
  • Page 56 and 57: Dandruff Dandruff is a common condi
  • Page 58 and 59: Dermatitis/Eczema Dermatitis is a g
  • Page 60 and 61: Diabetes Diabetes is a condition in
  • Page 62 and 63: Diarrhoea and Vomiting Diarrhoea an
  • Page 64 and 65: Dry Skin Dry skin is skin that lack
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    Ear Conditions Our ears allow us to

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    Eye Conditions Almost two-thirds of

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    Eye Conditions (continued) Type Sym

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    Eyes: Contact Lenses Contact lenses

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    Fever What is fever Fever is define

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    Foot Care Common foot problems incl

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    Fungal Infections: Superficial Supe

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    Fungal Nail Infections (Onychomycos

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    Gout Historically known as the “d

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    Haemorrhoids Haemorrhoids (also cal

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    Hair Loss Alopecia is the medical t

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    Hay Fever Hay fever (also called in

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    Hay Fever (continued) TREATMENT OPT

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    Headache Headaches are common and c

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    Head Lice Head lice (pediculosis ca

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    Heart Health Cardiovascular (CV) di

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    Indigestion, Heartburn and Gastriti

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    Influenza Influenza (flu) is a comm

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    Influenza (continued) TREATMENT OPT

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    Iron Deficiency Iron is an essentia

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    Irritable Bowel Syndrome Irritable

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    Menopause Menopause - the “change

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    Migraine Migraines are a type of se

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    Muscular Aches, Pains and Tightness

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    Nappy Rash Nappy rash is a red rash

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    Oral Health Oral health disorders i

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    Osteoarthritis Osteoarthritis is th

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    Osteoporosis Osteoporosis (meaning

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    Period Pain and Endometriosis Perio

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    Poisonings Any substance that has t

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    Pregnancy Tests and Supplements Hom

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    Preventive Health There are certain

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    Probiotics and Prebiotics Probiotic

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    Psoriasis Psoriasis is a long-term

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    Scabies Scabies is a very contagiou

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    Shingles Shingles (herpes zoster) i

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    Sinus and Nasal Problems Sinuses ar

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    Sleep Problems and Snoring Sleep is

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    Smoking Cessation Almost 5000 New Z

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    Sore Throat Sore throats are very c

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    Strains and Sprains Sprains and str

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    Sun Care Sunburn Sunburn occurs fro

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    Sun Care: Eye Protection Protecting

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    Sweating: Excessive (Hyperhidrosis)

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    Toothache Toothache is the term use

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    Travel Health (including Vaccinatio

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    Travel Sickness Travel, or motion,

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    Urinary Incontinence Urinary incont

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    Urticaria (Hives) Urticaria refers

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    Vaginal Health The vagina is a clos

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    Varicose Veins and Support Stocking

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    Vitamins and Dietary Supplements Vi

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    Warts Warts are benign (non-cancero

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    Weight Loss Obesity has reached epi

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    Worms Pinworms (Enterobius vermicul

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    Wound Care Our skin acts as a barri

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    Wound Care (continued) Wound type M

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    Chapter References (continued) Diar

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    Chapter References (continued) Gord

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    Significant learning opportunity: W

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    PharmacyToday A part of your everyd

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    OTC Medicines: Interactions When se

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Precautions OTC Medi

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    OTC Medicines: Precautions OTC Medi

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    OTC Medicines: Adverse Effects OTC

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    Herbal Supplements: Interactions He

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    Herbal Supplements: Interactions He

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    Herbal Supplements: Interactions He

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    Herbal Supplements: Interactions He

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    Drugs in Sport Treating Athletes Me

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    Drugs in Aviation AVIATION - PRECAU

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    Drugs in Pregnancy Drug use in preg

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    NZ Support Groups ADHD Association

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    NZ Support Groups New Zealand AIDS

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    HEAT or INFLAMMATION Unlike heat ru

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    OTC Products Over-the-counter produ

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    OTC Products Index Foot Care - Fung

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    »» Childhood Pain and Baby Teethi

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    »» Foot Care - Fungal Infections

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  • Page 258 and 259:

    »» Irritable Bowel Syndrome GASTR

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  • Page 266 and 267:

    »» Sexual Wellbeing - Contracepti

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    An ENHANCED ELearning Experience As

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    Product Index ANIME LUBRICANT 50ML-

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    Manufacturer’s Index AFT Pharmace

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    Topiramate Actavis Topiramate 25mg,

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