Dry Skin Dry skin is skin that lacks moisture or oils, and is often characterised by wrinkling or fine lines, scaling, cracking and itchiness. It is common, particularly as people age and their skin becomes thinner and less able to retain moisture. Although it is not usually a serious problem, it can be uncomfortable, itchy and unsightly, and contribute to the appearance of ageing. The outer layers of the skin are made up of skin cells, oil and water. This outermost skin barrier can break down due to wear and tear from the environment, such as from the wind, sun, frequent washing or exposure to irritant substances. When this happens, oil and water are lost from the skin, causing dryness and sometimes itching. The skin may also become rough or scaly and small flakes of dead skin may be visible. If a red rash is present, this may indicate the development of dermatitis/eczema (see Dermatitis/Eczema). Any part of the body may be affected. Some people are born with a tendency towards dry skin, whereas others may develop it as a result of excessive bathing or swimming (particularly in water that is chlorinated), overuse of soap or other products that strip natural oils from the skin, or from spending too much time in dry air, such as in air-conditioned rooms. Other causes include cold weather and artificial heat exposure (such as heaters, fires, electric blankets), low humidity climates, over exposure to the sun and wearing clothes that chafe the skin (eg, wool). Initial assessment Ask your customer for permission to touch their skin. Very dry skin feels quite rough and firm to the touch. Redness and deep cracks, and large flakey scales are usually also present when the skin is extremely dry. Thicker moisturisers with a high oil content (eg, ointments) are best for very dry skin. However, people may prefer less greasy creams and lotions, especially when the dryness is mild. Refer any customers with allergies to topical products or with "yes" answers to the Refer to Pharmacist questions to a pharmacist. TREATMENT OPTIONS Category Examples Comments Soap substitutes Moisturisers and emollients Lip balms for dry lips/nasal gel for dry nasal passages Barrier creams Anti-pruritic (anti-itch) preparations Bath/shower products [GENERAL SALE] eg, Alpha Keri range, Aqueous Cream, Baby Body Soap, DermaLab Gentle Cleansing, Ecostore Hand & Body Wash, Dermaveen, Emulsifying Ointment, Hopes Relief, QV Gentle Wash [GENERAL SALE] eg, Atoderm, DermaLab range, Ecostore range, Hopes Relief Itchy Dry Skin, Lipobase Cream, Lucas Paw Paw ointment, Palmer’s Skin Therapy Oil*, QV Skin Lotion, Rosken Skin Repair Dry Skin Cream, Trilogy range [GENERAL SALE] eg, Badger range, Carmex Lip Balm, Fess Nasal Gel, HayMax, Nivea range, QV Lip Balm [GENERAL SALE] eg, dimethicone (DU IT Tough Hands, Silic 15), zinc (Mustela Vitamin Barrier cream), zinc and castor oil [GENERAL SALE] eg, Pinetarsol MOISTURISE ALL ALL OVER OVER [GENERAL SALE] eg, Alpha Keri Oil, Scratchy & Itchy Soothing Bath, QV range [PHARMACY ONLY MEDICINE] eg, Oilatum Plus Soap substitutes are mild cleansers which do not strip the skin of its natural oils. Use of a soap-free cleanser or soap substitute is important for people with dry skin to prevent further drying. If using aqueous cream or emulsifying ointment put a small knob into a jar, add hot water and shake to form a liquid soap substitute. Never use aqueous cream as a moisturiser, only as a soap substitute as it contains sodium lauryl sulphate (a detergent) which may aggravate dermatitis. Regular use of a moisturiser improves the skin’s ability to function properly and act as a barrier. Customers may need to try several products before they find one that they like with the right amount of greasiness. 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. Some people are allergic to lanolin. Formulated to adhere to mucus membranes of the lips or inside of the nose. Contain moisturisers to help with chafing, cracking and soreness. HayMax moisturises and prevents dust, pet dander, and pollen from entering the nose. Provide qv a barrier Bath between oiL the skin and outside influences (eg, water, detergent). qv cReam Apply regularly, especially on hands just before Recommend immersing them in water. with Tar-based, pine-oil products are useful in the bath to help reduce itching. A few people are allergic to pine oil and should avoid it. Bath oils containing antiseptics may be useful in people with dry skin and dermatitis to reduce flare-ups due to bacterial colonisation. Use no more than the recommended amount. Warn about the danger of slipping. Natural / herbal products / Almond oil, Aloe Vera, alphahydroxy acids AHAs are natural acids found in foods that work by exfoliating the top layers of dead skin supplements (AHAs), avocado, coconut oil, honey, lecithin, cells, improving the skin’s appearance and reducing blemishes and age spots. Coconut oil qv Bath qv oiL Bath oiL mango, oatmeal, sesame oil qv cReam qv cReamimproves skin moisture and oil levels. Lecithin is used in topical products as a humectant. Recommend Recommend Several other natural ingredients help restore moisture to dry skin. with with qv wash Recommend qv sKin Lotion Products with an asterisk have a detailed listing in the Dry Skin section of OTC Products, starting on page 235. with Ideal for normal, dry and sensitive skin NORMAL TO TO DRY DRY NORMAL TO DRY MOISTURISE ALL OVER NORMAL TO DRY MOISTURISE DRIER ALL OVER DRIER qv wash qv wash QV WASH Recommend Recommend with with qv sKin qv Lotion sKin Lotion qv Bath oiL qv GentLe wash QV SKIN LOTION QV GENTLE WASH Recommend Recommend with with qv cReam qv cReam QV CREAM m DRIER DRIER Page 60 HEALTHCARE HANDBOOK 2017-2018 Common Disorders DRIEST NORMAL TO DRY R
CONTINUING OTC EDUCATION Treatment There are many different types of moisturisers available; all aim to rehydrate the outer layers of the skin and prevent further evaporation. Moisturisers usually contain a water-retaining substance, called a humectant (such as glycerin or hyaluronic acid), an emollient to smooth and lubricate the skin (usually a type of fat or oil such as lanolin), fragrances and preservatives. Some customers with sensitive skin may require hypoallergenic or unperfumed moisturisers, whereas others may look for a product which only contains natural or organic ingredients. Other ingredients commonly found in moisturisers include: • antioxidants (eg, acai oil, CoQ-10, grape seed, green tea extract, resveratrol, soy isoflavones, vitamin C & E) • ceramides – help maintain the skin's natural moisture barrier enhancing hydration • keratolytics (eg, urea or ammonium lactate) – used to remove flakes of dead skin but these may sting • linoleic/linolenic acids/phospholipids – fats that support the skin structure and reduce inflammation • menthol – provides a cooling effect and reduces itching • oatmeal – provides a protective barrier over the skin • shea butter – a non-toxic, solid, fatty oil with skin healing and moisturising benefits MOISTURISE ALL ALL OVER OVER • sunscreens – in day creams to protect against UV rays. Overall choice of moisturiser depends on aesthetic appeal, previous sensitivity reactions, cost, and personal preference, and customers may need to sample several before making their choice. qv Bath qv Bath oiL oiL qv cReam qv cReam Recommend Recommend Ichthyosis with with Ichthyosis is a skin condition characterised by persistently dry, thickened, rough, fish scale-like skin. There are over 20 different types of ichthyosis. The most common is the inherited form, ichthyosis vulgaris which affects 1:250 people with signs and symptoms usually becoming apparent in the first year of life. Ichthyosis can also be NORMAL acquired in adulthood TO TO often DRY associated DRY with systemic diseases such as hypothyroidism, sarcoidosis, lymphoma or HIV infection. It may also be provoked by the use of kava, nicotinic acid and hydroxyurea. There is no cure for ichthyosis and the main aim of treatment is to prevent dryness, qv wash qv scaling, washcracking, and the Recommend build-up Recommend of skin. Daily skin moisturisation qv sKin qv Lotion sKin and Lotion exfoliation is recommended and occasionally with withretinoids (acitretin, isotretinoin) may be prescribed to reduce scaling. Rubbing wet skin with a pumice stone before applying moisturiser may help to remove thickened crusty skin and trap in moisture. Lanolin creams and products containing urea and alphahydroxy acids can also be beneficial. Advice for customers DRIER DRIER • Try to identify and limit any contributing cause(s) if possible. • Avoid spending long periods Recommend of time Recommend in the sun and always use sun protection qv GentLe qv GentLe wash wash qv cReam qv cReam when outdoors during the day. with with 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)? • Is there a visible rash, eg, blistering, bumpy, red and/or inflamed skin? • Does the skin look infected or have pus or a discharge? • Are there any thickened patches of skin and/or silvery scales visible (eg, icthyosis, psoriasis)? • Does the dryness and itching interfere with sleeping? • Has the person already tried treatment products without success? • Is the customer a child? • Does the person have any allergies to topical medicines? • Bathe or shower less frequently – once a day is plenty – and use lukewarm water. Pat skin dry with a towel rather than vigorously rubbing. • Choose a mild soap or soap substitute, even when the skin is in good condition – normal soap is very alkaline and can irritate or dry the skin. • Dress appropriately for the weather. • Frequently moisturise. • Keep hydrated by drinking plenty of fluids. • Wear gloves or use a barrier cream if your hands are frequently in water. • Hypoallergenic or unperfumed skin products may be less irritating. Soap-free, irritant-free, fragrance-free DRIEST DRIEST MOISTURISE ALL ALL OVER OVER MOISTURISE ALL OVER qv intensive qv intensive QV INTENSIVE oistURisinG moistURisinG cLeanseR cLeanseR MOISTURISING CLEANSER Recommend Recommend with with R R qv intensive qv intensive qv Bath qv oiL Bath oiL BodY QV INTENSIVE BodY moistURise moistURise QV BATH OIL BODY MOISTURISE Recommend Recommend with with qv cReam qv cReam QV CREAM • • NORMAL TO TO DRY DRY Page 61
According to Stéphane Rossini, incoming Chairman of the Agency Council, the culture of collaboration will remain a factor in ensuring that Switzerland is successful in retaining a high-quality medicines control system: “A globalised economy and the international consumption of therapeutic products entail synergies and collaboration.”
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