Some 60 per cent of people have suffered a skin disease at some point, says the British Skin Foundation, with 28 per cent having experienced acne. Seven in 10 people have visible scars or visible skin conditions, with 72 per cent saying it affects their confidence.
Almost half (48 per cent) of dermatology nurses surveyed by the British Skin Foundation found that only about half of patients comply with treatment
for their skin condition.
“It would be helpful if pharmacy staff developed links with their local dermatology unit to understand how we use common treatments,” says consultant dermatologist Dr Anjali Mahto.
Skin conditions can cause emotional distress and it’s important to be mindful of this. “Always ensure your customer is made to feel comfortable when discussing their skin condition and take them somewhere private if possible,” says Avicenna pharmacist Simur Rahman at The Green Pharmacy in Luton. It’s a good idea to arrange a follow-up consultation with customers to discuss how they’re getting on with any treatments you recommend.
“Most pharmacies cater for dry skin conditions, but there are many other skin conditions your customers may suffer from,” says Beiersdorf UK medical manager Dylan Griffiths. “It’s important to be knowledgeable about a range of conditions. Become a community skincare centre that your customers can rely on.”
Acne affects about 80 per cent of people between the ages of 11 and 30 at some time and accounts for 3.5 million GP consultations each year. About 60 per cent of sufferers seek treatment, often over the counter.
Dermatologists are seeing an increase in acne in adults, especially women. “We see a lot more cases in our clinic,” says Dr Nick Lowe, consultant dermatologist at the Cranley Clinic and author of Perfectly Clear, a guide to managing acne. “I put this down to several things. Stress is a major factor today. Stress induces release of the hormone cortisol, which has an acne-inducing effect on the sebaceous glands, making them produce more sebum. We’ve also noticed a link between early use of the Pill and adult acne. Having babies later may also be a factor, thanks to the hormonal changes. Poor diet, and a diet rich in high-glycaemic foods, can have an effect, too.”
Dr Lowe stresses the importance of dealing with acne patients in a sensitive way. “Never underestimate the impact acne can have on quality of life,” he says. “It’s key to explain to your customer that there are many good treatment options, and selecting the right combination is vital.”
Most patients will respond to topical treatments. “However, be aware that topical retinoids can dry and irritate skin at first and many people give up because of this,” says Dr Lowe. “It’s important to refer customers if they are not responding to their OTC or prescribed treatments. Also remember that many prescribed products can’t be used in pregnancy, especially retinoids.”
If a patient has signs of severe acne – large red bumps or scarring – then topical treatments alone are unlikely to be helpful. “Patients should be advised to see their GP, who may either recommend antibiotic therapy or referral to a dermatologist for isotretinoin treatment,” says Dr Mahto. “Signs of scarring warrant referral to a dermatologist.”
Adult acne in women can also be treated with hormonal drugs, such as the contraceptive pill Yasmin. “Another way to treat it is with the diuretic drug spironolactone, which reduces the androgen stimulation of the sebaceous glands to help improve acne,” says Dr Lowe. “This can be used in combination with antibiotics, Roaccutane and oral contraceptives.”
In the summer months it’s important to remember that sunscreens can trigger a breakout. “Recommend one that is light and non-comedogenic to avoid blocking pores,” suggests Dr Lowe.
“One of the biggest problems we face as dermatologists is steroid phobia for skin conditions such as eczema,” Dr Mahto. “The patient information sheets often state they should be used sparingly and avoided on broken skin and genital areas. Patients are often then discouraged from using treatments in a way their dermatologist intended.”
Make sure patients know how to use their treatments. “Give lots of practical tips on how to apply emollients, such as not putting fingers in the pot, to avoid infection,” says Mr Rahman.
The National Eczema Society has published a booklet Living With Eczema For Adults, and another version for teenagers, both of which can be downloaded free from eczema.org. Both are packed with practical advice on managing the condition, the latest treatments and trigger factors.
In the summer months, customers will welcome your advice on choosing the right sunscreen. The National Eczema Society advises that any new sunscreen is properly tested before taking it on holiday. Advise people to dab a little on the forearm once a day for five days to check for a reaction. Many people find a physical, mineral-based sunscreen is less irritating than a chemical sunscreen.
Fires associated with the use of emollients that contain paraffin – often when it soaks into bedding and clothes that aren’t washed frequently – have been in the news recently. “It’s important to highlight this potential danger to your customers who use these emollients,” says Dylan Griffiths, medical manager at Beiersdorf UK. “There will be warnings on packaging in the future, but meanwhile you can help by reminding customers of this potential hazard.”
According to Mintel, 21 per cent of female facial skincare users have used pharmacy brands in the past 12 months. The experience of skin allergies may be driving this, as women who’ve had an allergic reaction are more likely to use a pharmacy brand, says Mintel. Also, a lower percentage of women are seeking advice from a dermatologist. This presents opportunities for better information at point of sale, especially for medical skin concerns.
“We’ve seen a move away from wipes, which is consistent with what we’re seeing across the entire skincare category,” says Chloe Humphreys-Page at IRI. “Customers are moving to products such as pore strips. The wash segment is still the largest contributor to the overall category, but this is where we’ve also seen the greatest losses. Cleansers and strips were the most successful in this area.”
The medicated facial skincare market is worth £7.9 million (IRI, year to February 2017), down by 2.4 per cent on last year. Sales of strip products have grown by 31 per cent in the past year and medicated cleansers by 9.8 per cent.
Eight in 10 of people fail to apply sunscreen properly before going out in the sun, according to a survey by the British Association of Dermatologists (BAD). This also revealed that 70 per cent of people don’t reapply sunscreen every two hours as recommended, while 72 per cent admitted they had been sunburnt in the past year.
Cases of the most common skin cancers – basal cell carcinoma and squamous cell carcinoma – are set to rise by 78 per cent by 2025, according to the BAD. “Pharmacists can help by educating the public on the importance of sunscreen and sun protection behaviour,” says Dr Mahto.
“This includes using SPF15 to 30 all year round, covering up as much as possible in the sun, avoiding the sun between 11am and 3pm and wearing a hat and sunglasses. If a patient is on a drug that suppresses their immune system, this is also a good opportunity for education about sun protection. Immuno-suppressed individuals are at higher risk of developing skin cancer.”
Mr Griffiths stresses the need to highlight sun protection in customers with skin conditions. “Using a moisturiser that contains an SPF won’t be enough in the summer months,” he says. “If a customer is using retinoids for their skin condition, their skin will be more sensitive to sunlight.”
Highlight the issue by dedicating a month to skin cancer awareness in your store. “Put leaflets about sun awareness in medication bags,” says Mr Rahman. “It’s a good idea to set your team a target of speaking to three to four people each week about sun awareness.”
Mole awareness and regular checking is something pharmacy staff could get more involved with. Alphega Pharmacy offers customers a mole screening service. This helps to raise awareness and provides customers with a checking service.
Avicenna pharmacist Dignesh Unjiya at Blyth’s Meadow surgery pharmacy in Braintree, Essex, believes there’s a role for pharmacy mole checking services. “Many people don’t know what they should be looking for, so we could help with this,” he says.
Pharmacies have the opportunity to stock some specialist products that multiples and supermarkets don’t usually carry.
Lila Thakerar, pharmacist at Shaftesbury pharmacy in Harrow, says: “Keep up to date with all the latest products and relaunches so you can pass on information to your customers. Do your CPD modules and encourage staff to do online training modules.” Alter your stock range with the seasons as skincare needs change from winter to summer, she suggests, but don’t clutter the section. “If products are identical in terms of ingredients, just stock one or two brands, otherwise it’s confusing.”
“Stock a few units of a wide variety of skin products because you need a tailored approach,” says Mr Rahman. “Customers may need to try out several creams before they find one to suit their skin.”
“Help customers to distinguish between different types of emollient for their skin condition, and educate them on how to best apply them,” says Mr Unjiya, adding his advice to keep a good range of fragrance-free products for skin conditions.
Bina Patel, Kalsons Chemist, Westcliff-on-sea, Essex “This is my field of interest and this is an important category. I prescribe for conditions such as eczema, psoriasis, allergic dermatitis, dry skin and acne. I work with the nearby private dermatology clinic, and take photographs if it’s something I can’t manage. Today, for example, I had a patient with urticaria and hives and I was advising her on diet and lifestyle, the products she can use and how she can try to prevent it. Because I’m near a high school, acne and eczema are probably the most common problems I see. The best place to start is with OTC medicines and then if you give people good, supportive advice, they will come back. The largest OTC brands in this category for us are Aveeno, Oilatum and Dermalex, and I’ve seen good results with those. It’s a good category to get involved in; my reputation has been built on it.”
Jess Williams, Kellaway Pharmacy, Bristol “Our community has lots of young families, and we get many concerned parents asking about a variety of skin conditions, eg eczema, dry skin, cradle cap, nappy rash, slap cheek etc. Our team is trained to advise people about product choice: this can be a very emotive area and it is important for the patient to find the right product that is effective and also suits their personal preference e.g. oil-based, water-based; frequency of use. Value for money is also a factor, plus CCGs have particular products on their list, which while evidence-based, may not suit a patient’s preference. Advising on use is important, ie how and when to use creams, wash and emollients alongside products prescribed by the GP, and to be persistent (it can take weeks for improvement).”
Mejebi Eyewuoma, Abbotswood Pharmacy, Yate, South Gloucestershire “This is an important category for our pharmacy, and our advice is increasingly useful as the wait for a GP appointment is getting longer – some patients say they have had to wait for up to a week to see a GP. Eczema is a routine reason that patients visit the pharmacy, and it is important to identify the exact type of eczema someone has to be able to recommend a suitable product. However, most people are not sure what type of skin condition they have. Our staff have been trained on a broad range of OTC products for dry skin conditions and will seek pharmacist advice when inflammation, itching and other medicines are involved. The itching with eczema can be particularly distressing.”