2017 HCHB_digital

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.
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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,
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