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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 11 and 12: HELP KIDS BE THEMSELVES AGAIN NEW L
  • Page 14 and 15: NUROFEN ZAVANCE* IS ABSORBED UP TO
  • 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

  • Page 68 and 69:

    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

  • Page 76 and 77:

    Foot Care Common foot problems incl

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    Fungal Infections: Superficial Supe

  • Page 80 and 81:

    Fungal Nail Infections (Onychomycos

  • Page 82 and 83:

    Gout Historically known as the “d

  • Page 84 and 85:

    Haemorrhoids Haemorrhoids (also cal

  • Page 86 and 87:

    Hair Loss Alopecia is the medical t

  • Page 88 and 89:

    Hay Fever Hay fever (also called in

  • Page 90 and 91:

    Hay Fever (continued) TREATMENT OPT

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    Headache Headaches are common and c

  • Page 94 and 95:

    Head Lice Head lice (pediculosis ca

  • Page 96 and 97:

    Heart Health Cardiovascular (CV) di

  • Page 98 and 99:

    Indigestion, Heartburn and Gastriti

  • Page 100 and 101:

    Influenza Influenza (flu) is a comm

  • Page 102 and 103:

    Influenza (continued) TREATMENT OPT

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    Iron Deficiency Iron is an essentia

  • Page 106 and 107:

    Irritable Bowel Syndrome Irritable

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    Menopause Menopause - the “change

  • Page 110 and 111:

    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

  • Page 128 and 129:

    Preventive Health There are certain

  • Page 130 and 131:

    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

  • Page 138 and 139:

    Sinus and Nasal Problems Sinuses ar

  • Page 140 and 141:

    Sleep Problems and Snoring Sleep is

  • Page 142 and 143:

    Smoking Cessation Almost 5000 New Z

  • Page 144 and 145:

    Sore Throat Sore throats are very c

  • Page 146 and 147:

    Strains and Sprains Sprains and str

  • Page 148 and 149:

    Sun Care Sunburn Sunburn occurs fro

  • Page 150 and 151:

    Sun Care: Eye Protection Protecting

  • Page 152 and 153:

    Sweating: Excessive (Hyperhidrosis)

  • Page 154 and 155:

    Toothache Toothache is the term use

  • Page 156 and 157:

    Travel Health (including Vaccinatio

  • Page 158 and 159:

    Travel Sickness Travel, or motion,

  • Page 160 and 161:

    Urinary Incontinence Urinary incont

  • Page 162 and 163:

    Urticaria (Hives) Urticaria refers

  • Page 164 and 165:

    Vaginal Health The vagina is a clos

  • Page 166 and 167:

    Varicose Veins and Support Stocking

  • Page 168 and 169:

    Vitamins and Dietary Supplements Vi

  • Page 170 and 171:

    Warts Warts are benign (non-cancero

  • Page 172 and 173:

    Weight Loss Obesity has reached epi

  • Page 174 and 175:

    Worms Pinworms (Enterobius vermicul

  • Page 176 and 177:

    Wound Care Our skin acts as a barri

  • Page 178 and 179:

    Wound Care (continued) Wound type M

  • Page 180 and 181:

    Glossary WHAT DOES THAT WORD MEAN?

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    Chapter References (continued) Diar

  • Page 184 and 185:

    Chapter References (continued) Gord

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    Significant learning opportunity: W

  • Page 188 and 189:

    PharmacyToday A part of your everyd

  • Page 190 and 191:

    OTC Medicines: Interactions When se

  • Page 192 and 193:

    OTC Medicines: Interactions OTC Med

  • Page 194 and 195:

    OTC Medicines: Interactions OTC Med

  • Page 196 and 197:

    OTC Medicines: Interactions OTC Med

  • Page 198 and 199:

    OTC Medicines: Precautions OTC Medi

  • Page 200 and 201:

    OTC Medicines: Precautions OTC Medi

  • Page 202 and 203:

    OTC Medicines: Adverse Effects OTC

  • Page 204 and 205:

    Herbal Supplements: Interactions He

  • Page 206 and 207:

    Herbal Supplements: Interactions He

  • Page 208 and 209:

    Herbal Supplements: Interactions He

  • Page 210 and 211:

    Herbal Supplements: Interactions He

  • Page 212 and 213:

    Drugs in Sport Treating Athletes Me

  • Page 214 and 215:

    Drugs in Aviation AVIATION - PRECAU

  • Page 216 and 217:

    Drugs in Pregnancy Drug use in preg

  • Page 218 and 219:

    NZ Support Groups ADHD Association

  • Page 220 and 221:

    NZ Support Groups New Zealand AIDS

  • Page 222 and 223:

    HEAT or INFLAMMATION Unlike heat ru

  • Page 224 and 225:

    OTC Products Over-the-counter produ

  • Page 226 and 227:

    OTC Products Index Foot Care - Fung

  • Page 228 and 229:

    »» Acne CRYSTADERM CREAM AFT PHAR

  • Page 230 and 231:

    »» Childhood Pain and Baby Teethi

  • Page 232 and 233:

    »» Colds BONNINGTON’S IRISH MOS

  • Page 234 and 235:

    CODRAL RELIEF MAX STRENGTH COLD & F

  • Page 236 and 237:

    OTRIVIN JUNIOR GLAXOSMITHKLINE CONS

  • Page 238 and 239:

    DULCOLAX SANOFI CONSUMER HEALTHCARE

  • Page 240 and 241:

    BENADRYL MUCUS RELIEF DOUBLE ACTION

  • Page 242 and 243:

    »» Dandruff COCO-SCALP AFT PHARMA

  • Page 244 and 245:

    EAR CLEAR WILSON CONSUMER PRODUCTS

  • Page 246 and 247:

    »» Foot Care - Fungal Infections

  • Page 248 and 249:

    TELFAST ORAL LIQUID SANOFI CONSUMER

  • Page 250 and 251:

    NUROFEN ZAVANCE RECKITT BENCKISER (

  • Page 252 and 253:

    MOOV HEAD LICE SOLUTION DOUGLAS PHA

  • Page 254 and 255:

    GAVISCON DUAL ACTION LIQUID RECKITT

  • Page 256 and 257:

    CODRAL COLD & FLU + COUGH JOHNSON &

  • Page 258 and 259:

    »» Irritable Bowel Syndrome GASTR

  • Page 260 and 261:

    VOLTAREN EMULGEL GLAXOSMITHKLINE CO

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    TURMERIC EXTRA STRENGTH GOOD HEALTH

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    PREGNOSIS EARLY PREGNANCY TEST DIP

  • Page 266 and 267:

    »» Sexual Wellbeing - Contracepti

  • Page 268 and 269:

    SUDAFED PE SINUS DAY + NIGHT RELIEF

  • Page 270 and 271:

    NICORETTE INHALATOR JOHNSON & JOHNS

  • Page 272 and 273:

    STREPSILS PLUS LOZENGES RECKITT BEN

  • Page 274 and 275:

    TRAVACALM TRAVEL BAND WILSON CONSUM

  • Page 276 and 277:

    CRYSTADERM CREAM AFT PHARMACEUTICAL

  • Page 278 and 279:

    An ENHANCED ELearning Experience As

  • Page 280 and 281:

    Product Index ANIME LUBRICANT 50ML-

  • Page 282 and 283:

    Manufacturer’s Index AFT Pharmace

  • Page 284:

    Topiramate Actavis Topiramate 25mg,

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