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2017 HCHB_digital


Dermatitis/Eczema Dermatitis is a general term used to describe skin inflammation. Some people use the word “eczema” interchangeably with dermatitis. Dermatitis is common and characteristic symptoms include an intense redness of the skin or scalp, with raised bumpy areas and sometimes bleeding, blistered or weepy patches. These patches can be incredibly itchy and may interfere with sleep and other activities. Constant scratching can cause skin changes and affect pigmentation. Dermatitis may flare-up occasionally, or be present all the time. It is usually classified according to its known or suspected cause, for example, irritant contact dermatitis, allergic contact dermatitis, atopic dermatitis, and seborrhoeic dermatitis. Irritant contact dermatitis This is the most common form of dermatitis and frequently occurs in people exposed to irritant substances such as chemicals, disinfectants, fragrances, and soaps which remove natural oils from the skin. The skin may take on a glazed, parched, or scalded appearance. The area is usually sharply circumscribed and healing begins promptly on withdrawal of the offending agent. Hands are most commonly affected. Allergic contact dermatitis This is a skin reaction which results from contact with an allergen (eg, ingredients in cosmetics, dyes in clothing or footwear, hair dyes, latex gloves or condoms, nail polish, nickel in jewellery, plants, sticking plasters, sunscreen). A rash featuring red, raised welts confined to the area contacted by the allergen is the most typical symptom. Atopic dermatitis Atopic dermatitis (AD) is a skin condition characterised by recurring dermatitis associated with itch. Most people with AD have a predisposition to TREATMENT OPTIONS Category Examples Comments Soap substitutes Moisturisers Barrier creams [GENERAL SALE] eg, Alpha Keri Clear Wash, aqueous cream, Dermalab Gentle Cleansing, Dermasoft, Dermaveen, emulsifying Ointment, Hopes Relief, QV Gentle Wash* [GENERAL SALE] eg, Alpha Keri, Dermalab Stay Hydrated*, Dermasoft, Lipobase Cream, Lucas Paw Paw ointment, QV Skin Lotion*, Scratchy & Itchy Soothing Gel, XmaEase [GENERAL SALE] eg, dimethicone (DU IT Tough Hands, Silic 15), zinc (Mustela Vitamin Barrier cream), zinc and castor oil Use of a soap-free cleanser or soap substitute is important for people with dermatitis. To use aqueous cream or emulsifying ointment as a soap substitute, put a small knob into a jar, add hot water and shake, apply and wash off. Never use aqueous cream as a moisturiser because it contains sodium lauryl sulphate (a detergent) which may aggravate dermatitis. Regular use of a moisturiser improves the skin’s function as a barrier. The base used to make the cream and dissolve any ingredients plays just as important a role as the active ingredients themselves. Humectants (eg, glycerin, oatmeal, propylene glycol, phospholipids) hold water in the skin. Ointments containing petrolatum or lanolin tend to be greasier than creams. Provide a barrier between the skin and outside influences (eg, water, detergent). Apply regularly, especially on hands just before immersing them in water. Anti-pruritics (anti-itch) [GENERAL SALE] eg, Pinetarsol range* Tar-based pine oil products are useful to help reduce itching. Some people may be allergic. Itchy scalp [GENERAL SALE] eg, Coco-Scalp* Contains ingredients that break down scalp scale, relieve itch, and condition the hair. Bath/shower products Anti-inflammatory products [GENERAL SALE] eg, Alpha Keri Oil, Scratchy & Itchy Soothing Bath, QV range [PHARMACY ONLY MEDICINE] eg, Oilatum Plus [GENERAL SALE] eg, Ichthammol, (Egoderm Cream, Egoderm Ointment [with zinc]) Bath oils containing antiseptics may be useful in dermatitis to reduce flare-ups due to bacterial colonisation. Use no more than the recommended amount. Warn about slipping. Half a cup of regular bleach added to a 20cm deep bath twice a week can help prevent infection and improve dermatitis. Can reduce flare-ups associated with eczema. Topical corticosteroids Products for cradle cap Natural / herbal products / supplements [PHARMACY ONLY MEDICINE] eg, hydrocortisone 0.5% (Derm-Aid Soft 0.5%, Skincalm 0.5%) [PHARMACIST ONLY MEDICINE] eg, hydrocortisone 1% (Derm-Aid Soft 1%, Skincalm 1%), Clobetasone 0.05% (Eumovate) [GENERAL SALE] eg, Egozite Cradle Cap, Mustela Stelaker, Kiwiherb Baby Balm eg, Artemis Itch Calm, Eczema Comp, Mebo Antiitch, Omega 3/6, Bifidobacterium, Lactobacillus Do not apply to broken skin or to face. Apply a small amount no more than twice daily, and limit use to one week at a time. Long-term use may result in skin thinning and stretch marks. Loosens and removes the crusts due to cradle cap. Natural ingredients soothe the skin and reduce the urge to scratch. Oral Bifidobacterium or Lactobacillus can reduce atopic eczema severity in infants. Products with an asterisk have a detailed listing in the Dermatitis/Eczema section of OTC Products, starting on page 234. @PharmacyToday. A part of your everyday. New Zealand’s only e-newsletter designed specifically to provide a news snack for pharmacy. With links to you’re only a click away from the full story. Page 54 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION hypersensitivity-type conditions such as hay fever, asthma, chronic urticaria, or food allergies. AD tends to run in families and most commonly presents in childhood, although may occur at any age. AD tends to come and go with periods of activity (called flares) and periods of relative skin normality in between, although in most people the skin always appears slightly dry. Flares in AD usually occur following exposure to certain allergens or trigger factors including grasses, pollen, animal dander, dust mites, stress or temperature/climate change. Skin flexures (eg, elbows or behind the knees) are more commonly affected and usually symmetrically. Broken areas of skin are prone to infection, and raw or weepy looking rashes should be referred to the pharmacist. AD probably represents more than one condition, so there is no known single cause. Ongoing research is currently investigating how our immune system, digestive system, filaggrin gene mutations (filaggrin is a protein responsible for maintaining an effective skin barrier), defective keratinocytes (skin cells), and commensal microbes contribute to atopic dermatitis. Barrier defects appear to be a key factor of AD. Environmental factors (eg, weather, temperature, allergens) also play a part. Treatment may be required for many months and possibly years. It nearly always requires avoidance of trigger factors (where possible), regular moisturisers (see Treatment Options, previous page) and intermittent, short course (five to 15 days) topical corticosteroids. Topical calcineurin inhibitors (ie, pimecrolimus, tacrolimus), antibiotics, antihistamines, phototherapy or oral corticosteroids may also be needed. Seborrhoeic dermatitis This is a common, harmless, salmon pink, scaling rash which can affect the face, scalp, eyebrows, eyelid edges and other areas. It is most likely to occur where the skin is oily. Topical antifungals, occasional topical corticosteroids, and combination scalp products containing coal tar, coconut oil and other ingredients may keep the condition under control but it may be quite persistent. Scalp seborrhoeic dermatitis is a cause of dandruff. Cradle cap (infantile seborrhoeic dermatitis of the scalp) Cradle cap is a scaly, crusty, patchy, greasy, skin rash that occurs on the scalp of recently born babies. It is not usually itchy and most babies are not bothered by it. The cause is not clearly defined but may be due to overactive sebaceous glands in the skin of newborn babies, or a relationship with Malassezia yeasts. Mild baby shampoos and soft brushing can help remove the scales, although the rash usually clears up by itself by the time a baby is a year old. Some people use baby oil or paw paw ointment to soften the scales to allow easier removal. Olive oil should not be used as this encourages proliferation of Malassezia. 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)? • Is the person with dermatitis a child? • Is the skin broken or inflamed or are there signs of infection (ie, pus)? • Could the condition be related to a regular habit (eg, washing hands)? • Has the rash or cradle cap spread or worsened? • Does the rash contain vesicles (little pimples with clear fluid)? • Is the affected area covered with white patches or silvery scales? • Has the skin become tough and leathery? • Does the person have any allergies to topical medicines? discuss the appropriate treatment options, such as soothing creams, topical corticosteroids, and moisturisers. Advice for customers • Avoid factors which aggravate the dermatitis where possible. »» Limit contact if avoidance is not possible (eg, gloves, barrier creams). • Moisturise the skin often and liberally, especially after bathing (see also Dry Skin). • Replace soap with soap-free alternatives. Initial assessment Look at the dermatitis if possible and run through the Refer to pharmacist questions (this page) to decide who needs referring. For all other customers, Page 55

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