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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 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
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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

  • Page 220 and 221:

    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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  • Page 276 and 277:


  • Page 278 and 279:

    An ENHANCED ELearning Experience As

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    Product Index ANIME LUBRICANT 50ML-

  • Page 282 and 283:

    Manufacturer’s Index AFT Pharmace

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    Topiramate Actavis Topiramate 25mg,

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