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2017 HCHB_digital

Bruises, Scars, Spider

Bruises, Scars, Spider Veins Bruises Beneath our skin lies a network of tiny blood vessels called capillaries. A bruise forms when these capillaries break or burst as the result of an injury or blunt force, and blood leaks out and pools in the area. The area may swell and feel tender, and the bruise goes through several colour changes from dark red initially, to purple or black before fading to a yellowish/green as the body breaks down the pooled blood cells and the capillaries heal. People who are more likely to bruise include those with thinner skin (women, elderly) or more fragile blood vessels (elderly, long-term prednisone use). Bruises are also more likely to occur in areas where there is less fat, such as around the knees. Blood clotting is important in fixing the bruise, so clotting problems (eg, haemophilia, liver disease) or medication that affects clotting (eg, warfarin, aspirin or anti-inflammatories) can affect bruising. A haematoma is a hard lump where the blood clots or partly clots in a localised area (eg, in a muscle) and may need to be drained off. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is called an ecchymosis, and is common in elderly people. Light bruises are not dangerous but more serious bruises will need to be referred to a pharmacist or doctor. Spontaneous bruising may be the sign of a bleeding disorder or bone marrow problem. Scars Scars are permanent areas of fibrous tissue that grow over a wound. Part of the natural healing process, they can occur from surgery, burns, cuts and grazes, acne, skin infection, chickenpox and scratches. Scars are often thicker, pinker, redder, or shinier than normal skin. The functional ability of scars is less than that of normal tissue, and they do not contain sweat glands or hair follicles. Scars are also more prone to sunburn. How major the scar becomes depends on how big or deep the wound is, where it is, how long it takes to heal, the age and health of the person, TREATMENT OPTIONS Category Examples Comments Bruises Scars eg, arnica (eg, Anti-Flamme range, Natures Kiss Arnica cream) eg, mucopolysaccharide (eg, Hirudoid) Essential oils and vitamins eg, Derma Oil, Hiruscar Gel, Palmers Skin Therapy Oil*, Skybright Rosehip Oil, Trilogy Organic Rosehip Oil Support stem-cell regeneration eg, Mebo Skin Restore, Mebo Wound Repair Anti-Flamme cream contains a mixture of arnica flower and root and several essential oils to help relieve bruising. Hirudoid contains enzymes that help disperse excess fluid in swollen areas. Both creams also reduce swelling. These help reduce the appearance of scars and stretch marks. Helps return elasticity to damaged skin and fades scars and blemishes. It also protects newly healed skin. Veins Natural / herbal products / supplements Topical silicone gel eg, Bepanthen Scar Treatment, DermaScar, Dermatix, Epicyn Scar Reducing Silicone Gel Silicone gel sheets eg, Cica-Care Adhesive Silicone Gel Sheet eg, mucopolysaccharide (eg, Hirudoid) eg, essential oils and vitamins (eg, Bio-Oil) Spider veins Horse chestnut Bilberry extract Scars Alphahydroxy acids Rosehip or Tea Tree oil Vitamin E Bruises Comfrey (eg, Kiwiherb Comfrey) Arnica Traumeel gel/cream/drops Forms a flexible and transparent silicone sheet that acts like a second layer on the skin. Helps to flatten, soften and smooth hypertrophic and keloid scars. Recommended treatment duration: two months. Cica-Care softens, flattens and fades red, dark or raised scars. Use on fresh or old hypertrophic or keloid scars, or on closed wounds to help prevent hypertrophic scars and keloids. Cica-Care adheres to the skin. Use only after stitches have been removed. Spider veins can be treated with laser treatment, Intense Pulsed Light (IPL) therapy and sclerotherapy, although often other spider veins can develop in the same area. Hirudoid cream may be used to reduce vein inflammation under medical supervision. Bio-Oil may help reduce the appearance of spider veins. Oral horse chestnut seed extracts or bilberry extracts have been used in the treatment of vein conditions. Alphahydroxy acids applied as a facial peel appears to improve the appearance of atrophic acne scars. Rosehip oil can help to reduce the visible appearance of scars. Rosehip oil, diluted Tea Tree oil and vitamin E cream or capsules may help reduce scarring. Topical comfrey improves pain and tenderness of bruises. Arnica may help reduce bruising. Traumeel is a homeopathic range that may help with bruising. Products with an asterisk have a detailed listing in the Bruises, Scars & Spider Veinssection of OTC Products, on page 221. READY, SET, LEARN! Page 22 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION and the person's inherited tendency to scar. Scars should be dressed initially as the wound heals then taped with medical grade paper tape for a least eight to 12 weeks, and perhaps much longer. Keloid scars are raised, often red and can be bigger than the injury, surgery or acne causing them. Excess collagen forms as an abnormal response to the injury. Keloid scars can be treated with surgery, steroid injections, pressure and silicone gel sheets (eg, Cica-Care, see Treatment options opposite page). Even old scars can respond to treatment. Hypertrophic scars are similar to keloid scars but are no bigger than the injury. They can be treated with silicone gel sheets. Contracture scars may come from a burn. The skin becomes tight and can also affect mobility. Scars usually fade over time but never go away completely. Various treatments – such as surgery, dermabrasion, laser treatments, injections, chemical peels, creams or oils – can help minimise the appearance of a scar. Spider and reticular veins Spider veins (also called starbursts or telangiectasia) are similar to varicose veins but much smaller. They may be red, blue or purple and are closer to the surface of the skin than varicose veins (see Varicose Veins & Support Stockings). They usually occur in a group and look like a tree branch or spider web, and are commonly found on the legs and face. They can cover a very small or very large area of skin and can sometimes be painful. Reticular veins are bigger blue veins and lie deeper in the skin than spider veins. Spider veins often come from reticular veins, so these may need treating as well. Risk factors for developing spider veins include long-term use of strong topical corticosteroid creams, cirrhosis of the liver, heredity, prolonged standing, obesity, hormones and sun exposure. Treatment is available at vein clinics. Initial assessment Always be tactful when helping customers with obvious scars or spider veins as some people may be self-conscious about them. Unusual bruising, or bruising in an older person should always prompt you to ask the customer if they are taking any other medications or prone to bleeding, particularly if they are buying NSAIDs or aspirin, as further advice may be needed from a pharmacist. 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 allergies to topical medicines? Bruises • Is the area particularly painful or difficult to move? There may be damage, such as a fracture or sprain underneath. • Has the bruise swollen or become firm? • Has the bruise persisted for almost two weeks without fading? • Are there any other symptoms in addition to the bruising (eg, feeling unwell, headaches)? • Does the person bruise easily for no apparent reason? • Does the bruise cover a large area? Scars • Is the scar painful, very red, or extremely thick? • Is there any oozing, pus or blood coming from the scar? • Is the scarring extensive? Spider veins • Is the person using steroid creams? These may be the cause. • Has the person been unwell or do they have an underlying condition that might have caused the veins to appear? Veins • Wearing support hose, maintaining an ideal body weight, exercise and avoiding prolonged standing may help prevent spider veins. Advice for customers Bruising • Use RICE treatment (rest, ice, compression and elevation) straight after the soft tissue injury (see Strains and Sprains). Do not massage a bruise. Scarring • Use moist wound dressings and, if necessary, wound closure strips to help reduce scarring. Continue until the wound heals then tape for at least three months. Do not pick at wounds. Minimise movement of the area while healing. • Do not expose new scars to the sun – cover or apply sunblock. Locate this icon throughout the Healthcare Handbook. Then find the corresponding Pharmacy Today and ELearning articles. Read all three to unleash learning prizes and giveaways! Page 23

  • 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 16 and 17: Acne Acne is a common skin problem
  • 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 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
  • Page 66 and 67: Ear Conditions Our ears allow us to
  • Page 68 and 69: Eye Conditions Almost two-thirds of
  • Page 70 and 71: Eye Conditions (continued) Type Sym
  • Page 72 and 73: Eyes: Contact Lenses Contact lenses
  • Page 74 and 75: Fever What is fever Fever is define
  • Page 76 and 77:

    Foot Care Common foot problems incl

  • Page 78 and 79:

    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

  • Page 92 and 93:

    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

  • Page 104 and 105:

    Iron Deficiency Iron is an essentia

  • Page 106 and 107:

    Irritable Bowel Syndrome Irritable

  • Page 108 and 109:

    Menopause Menopause - the “change

  • Page 110 and 111:

    Migraine Migraines are a type of se

  • Page 112 and 113:

    Muscular Aches, Pains and Tightness

  • Page 114 and 115:

    Nappy Rash Nappy rash is a red rash

  • Page 116 and 117:

    Oral Health Oral health disorders i

  • Page 118 and 119:

    Osteoarthritis Osteoarthritis is th

  • Page 120 and 121:

    Osteoporosis Osteoporosis (meaning

  • Page 122 and 123:

    Period Pain and Endometriosis Perio

  • Page 124 and 125:

    Poisonings Any substance that has t

  • Page 126 and 127:

    Pregnancy Tests and Supplements Hom

  • Page 128 and 129:

    Preventive Health There are certain

  • Page 130 and 131:

    Probiotics and Prebiotics Probiotic

  • Page 132 and 133:

    Psoriasis Psoriasis is a long-term

  • Page 134 and 135:

    Scabies Scabies is a very contagiou

  • Page 136 and 137:

    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?

  • Page 182 and 183:

    Chapter References (continued) Diar

  • Page 184 and 185:

    Chapter References (continued) Gord

  • Page 186 and 187:

    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

  • Page 262 and 263:

    TURMERIC EXTRA STRENGTH GOOD HEALTH

  • Page 264 and 265:

    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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