Communications International Group © Consensio LLP trading as CIG Healthcare Partnership. Linen Hall, 162-168 Regent Street, London W1B 5TB. Tel: 0207 434 1530. For any queries regarding this training guide, call: 01284 717682 eczema & scalp conditions a training guide for the pharmacy BROUGHT TO YOU BY THE MAKERS OF OILATUM eczema, scalp conditions and your role in the pharmacy Eczema and some scaly scalp training objectives conditions can interfere with the daily After completing this guide, you will be able to: life of those who suffer from them. Identify the different types of eczema You are in an ideal position to offer Understand the impact that eczema can help, advice and knowledge to have on sufferers customers to help them deal with Understand the role that emollient therapy has their condition more effectively and allow them to get on with their lives. in managing the condition Be able to advise customers on correct application techniques This guide will look at eczema and some scaly scalp conditions that you Be able to identify scalp conditions and the different types of treatments available. may come across in the pharmacy. It can be used by both the pharmacist and pharmacy support staff to update knowledge and understanding of this key therapy area. Pharmacists and pharmacy technicians can also use this guide as a CPD opportunity. If you are a member of the pharmacy support staff, there is a case study and multiple choice questions to test your newly acquired knowledge. Remember to complete and return the multiple choice questions to receive a Certificate of Achievement. This training material has been approved by the National Pharmacy Association (NPA). The NPA in no way endorses any products, product ranges or treatment regimes mentioned in this material. 2 a training guide for the pharmacy eczema Eczema is a condition that causes the skin to be irritated, itchy and dry and it can be very distressing for anyone who suffers from it. It affects an enormous number of people to varying degrees, but unfortunately atopic eczema cannot be cured. However, it can be managed effectively with emollients (therapeutic moisturisers) so What is the pharmacy role ? Pharmacy is the perfect place for customers to come for expert advice on eczema. You are in an ideal position to help sufferers and their family members. By understanding the symptoms of eczema and the treatments available you will be able to offer advice on the use of emollients and lifestyle tips to these customers on how best to manage their skin condition. that symptoms can be minimised and sufferers are able to get on with their lives. When talking to the parents of eczema sufferers, listen for clues in the conversation which may suggest they need Did you know? your advice to help manage their child’s eczema. In a recent survey1 of childhood eczema, 59 per cent of respondents said that looking after a child with eczema had a considerable or huge impact on family life and regularly affected their family plans. This guide will equip you with the knowledge and skills you need to ensure that you are able to advise your customers about emollient therapy and how to use it to its best effect. This is because, used correctly, emollient therapy can significantly improve an eczema sufferer’s quality of life. The impact of eczema • Eczema affects one in five children and one in 12 adults • As well as physical symptoms, eczema can cause low self-esteem and a lack of confidence • 20 per cent of children with eczema are often bullied because of their skin. “ “ “ I am feeling very tired today as we all had a disturbed night because my little child was crying due to her itchy skin ” ” ” I am so upset as a total stranger stopped me to say my child was getting sunburnt and did not believe me when I explained it was eczema I am having one of those days – I feel quite down as my child has had a flare-up of eczema. I keep wondering if there is something I could have done to prevent it! a training guide for the pharmacy 3 What is eczema ? Who gets eczema ? Eczema is a dry skin condition that gets its name from the It is often children who suffer from eczema, although it Greek word ‘ekzein’, which means ‘to boil’. This should can affect people of all ages. help to give you an understanding of how eczema can make a person’s skin feel. You may find that sufferers describe their skin as dry, hot, red, inflamed and painful. The most common type of eczema among children is atopic eczema, which affects as many as 15 per cent of children by the age of seven. There are many different types of eczema and the severity of symptoms varies from person to person. In mild cases, a person’s skin may appear dry, scaly, red and itchy, and occasionally affect their sleep or stop them from doing certain activities. In more severe cases, the skin may be Atopic eczema is a genetic condition, which means that it runs in families, although it will often skip a generation. Children with atopic eczema may also have other conditions, such as asthma or hayfever. bleeding, crusting, weeping and prone to infection, leading to frequent disturbances of their sleep and affecting their daily routine. mild eczema “ Many children will ‘grow out’ of their condition, but it can sometimes reappear in later life ” Many children will ‘grow out’ of their condition, but it can sometimes reappear in later life. In 65 per cent of children, eczema will have disappeared by the time they are seven years of age. By the time they are 16 years old, about 74 per cent of children will be eczema-free. For adults, the cause of eczema can be quite different. You may find that a customer’s skin is reacting to a substance they have come into contact with at work or severe eczema home. Alternatively, the cause may be environmental (e.g. hot weather) or linked to medication or a pre-existing condition such as poor circulation. In babies and small children the symptoms most often affect the cheeks, forehead and limbs, whereas in older children and adults it often occurs in the skin folds such as behind the knees and in the crease of the elbows. 4 a training guide for the pharmacy common eczema triggers soap shower gel pollen washing up liquid Contact dermatitis The most common type of work-related skin disease. There are two types: • Irritant contact dermatitis – caused by contact with something that irritates the skin, such as soap, detergents, bleach, cement or raw food. Symptoms can heat nickel range from mild dryness and redness to skin that blisters as if it has been burnt Different types of eczema • Allergic contact dermatitis – caused by an allergy to a substance such as nickel, perfume or preservatives The following section will help you to recognise and found in toiletries, cosmetics and topical medicines. identify the different types of eczema. Symptoms include dry, red, split, cracked, weeping, Atopic eczema painful, itchy and stinging skin. Allergic contact dermatitis can occur suddenly, even if a person has The most common type of eczema in children. been used to a substance for many years. activity Think of the words and phrases that customers use to describe their eczema. Jot these words down in the space below: • Often starts in small patches on the cheeks around the mouth and neck and then spreads to other parts of the body, such as the creases of joints including the back of the knees and elbows. In some cases eczema more commonly affects the front of the knees and elbows, according to ethnic origin • The skin will be dry, itchy and prone to ‘flare-ups’, during which the condition worsens • Triggers for atopic eczema include soap, pollen, house dust mites, overheating or rough clothing. a training guide for the pharmacy 5 Managing atopic eczema The first line of managing eczema is ‘complete emollient therapy’. This is a simple, effective treatment that it is well known for its ability to significantly improve eczema symptoms and minimise the risk of ‘flare-ups’. Sufferers may also find that fragrance-free products are useful as they are less likely to cause irritation. Topical corticosteroids are a valuable tool in the management of eczema. The main value of them is that they reduce inflammation and speed up the healing of the skin. They also help to make the skin less red, hot, itchy and sore. Some products are available over the counter for mild cases of eczema. If someone is suffering from severe or inflamed eczema, you should refer them to the pharmacist, as they may need a topical corticosteroid or Emollients are therapeutic moisturisers that help to keep skin moist and flexible and thus allow it to feel more comfortable and less itchy. Unfortunately, although they are frequently prescribed or purchased, emollients are not often used properly, despite the fact that using them effectively may reduce the need for more potent treatments (e.g. topical steroids). another treatment that can be prescribed by their GP. Sufferers will be instructed by their GP on how often they need to apply topical steroids – most often they are applied sparingly twice daily. Advise customers that they should still use emollient therapy as well as the steroid preparations. There are no rules as to which should be applied first, but it is important to leave as long a period as possible (at least Emollients are the basis of any eczema management 15 minutes) between the two treatments. regime and other treatments can be used in conjunction with this (see the table of the stepped approach below). Using emollient therapy is not difficult, but research suggests that few people are ever shown the correct There are NICE guidelines for treating atopic eczema. way to apply emollients, which means that many This is a stepped approach, and GPs will often apply this eczema sufferers are not able to reap the full benefits. principle to sufferers. Discuss this with your team members. Systemic therapy Phototherapy 6 Wet or paste medicated bandages Wet or paste medicated bandages Other topical treatments Other topical treatments Mild potency topical corticosteroids Moderate potency topical corticosteroids Potent topical corticosteroids Emollients Emollients Emollients mild atopic eczema moderate atopic eczema severe atopic eczema a training guide for the pharmacy “ The basis of complete emollient therapy is the use of a combination of emollient creams, ointments, bath oils and soap substitutes to manage the symptoms of eczema. Complete emollient therapy helps to ensure that the sufficient quantity of emollient is applied throughout the day, by using a combination of products to suit lifestyle requirements. ” How do emollients work ? Emollients are made up of water, oils, fats and waxes, often containing one or more of these active ingredients: • Liquid paraffin • White soft paraffin • Emulsifying ointment. Emollients work by: • Providing an oily layer over the surface of the skin • Trapping water underneath the oily layer and preventing evaporation • Rehydrating the skin • Reducing penetration of irritants and allergens Soap substitutes • Soothing irritated and itchy skin People with eczema should avoid using soap as it can be very drying to the skin and can cause flare-ups. Instead, • Having a cleansing property so that a soap product is recommend an emollient soap substitute. These products not needed. do not foam like traditional soaps, but they are just as Types of emollients Emollients are available in a range of formats. These should be fragrance-free where possible. effective at cleaning the skin. Bath additives Using a bath additive helps to soothe itching, rehydrate and cleanse the skin. Customers should be advised to Creams bathe once or twice a day for 10 to 20 minutes if possible, Emollient creams contain a mixture of oils and water and using one to three capfuls of bath additives in lukewarm feel light and cool to the skin. They soften and rehydrate water. The skin should be patted dry (not rubbed) and the skin. NB: It’s easy for a pot of emollient cream to followed by an application of emollient cream or lotion to become contaminated with bacteria and act as a source lock in moisture. Like soap, normal bubble baths can be of infection. To avoid this risk, recommend a pump very drying to the skin and should be avoided by people dispenser if possible. Alternatively, advise the customer to with eczema. spoon out the cream onto a clean plate and use this instead of dipping their hands into the pot. Wash gels These products offer the same benefits as emollient bath Lotions additives, but require a shorter contact time with the skin. Lotions contain more water and less fat than creams. This means that they can be used under running water They are especially useful for customers who want to (e.g. in the shower or at a hand basin). cover large areas of the body or hairy areas of the body. The lotion keeps skin soft and supple. Oilatum offers a complete range of emollients. a training guide for the pharmacy 7 Education, education, education • Help customers to know what quantities (such as 250g or 500g) look like by using the jars and tubs as guidance Although it’s easy to tell customers that complete emollient therapy is the best way to manage eczema, • Advise customers to apply emollients to all parts of the body and not just the affected parts some customers may not actually know what this means and others may not be aware of the correct application • Use information leaflets to help emphasise important points about eczema. techniques. This is where your advice can make all the difference. Research shows that pharmacy intervention in educating patients and parents of children with eczema about the role of emollients can really improve eczema symptoms. Practical advice for customers Explain the importance of ‘complete emollient therapy’ and “ 37 per cent of mums feel helpless, frustrated and even angry, especially when their children’s skin is red and inflamed – they just want to make them better how it can improve symptoms and reduce the effect the condition has on customers’ lives. These types of conversations can occur when you are helping a customer You can also advise customers to: ” • Apply emollient cream after a bath with bath additives who is: • Warm emollient cream in the hands first – this makes it • Seeking advice on products to treat dry skin • Requesting help as their child is not sleeping due to itchy skin. You can also take the opportunity to start these conversations when handing out a prescription for emollients to check the customer understands how to use easier to apply • Apply extra emollients in extreme or harsh weather conditions • Apply frequently – ideally, three or four times a day • Continue to use emollients, even when the eczema has improved, as this will help to prevent flare-ups. the products. You can: • Offer customers a practical demonstration of how to use 30 per cent of mums said they were too tired to apply emollients to their children as often as they emollients properly (i.e. they should be stroked or should. Helping customers to choose the right smoothed onto the skin in the direction of hair growth – therapy for them will improve the eczema and this never rubbed into the skin as this can trigger itching and will in turn improve the quality of family life. block hair follicles) • Explain that some emollients can be used to clean the dirt from the skin and so there is no need to use soap • Tell customers to use plenty of emollients (250-500g of cream a week is not unusual, even for a child) 8 Did you know? a training guide for the pharmacy activity In the table below, list the emollient products that your pharmacy stocks and suggest the types of customers each product would be suitable for. Formulation Product name Main ingredients Directions for use Suitable for Bath additive Cream Wash gel Soap substitutes Lotion Helping customers to choose the right products Remember that people with eczema or parents of children WWHAM questions with eczema are often embarrassed about the condition, W ho is the medicine for? so whenever you are talking to a customer about eczema, W hat are the symptoms? it is crucial that you do so with tact and understanding. H ow long have the symptoms been present? It is also important to bear in mind that even if the symptoms don’t seem particularly severe to you, they are probably very worrying and troublesome to the customer. A ction already taken? M edicines taken for any other reason? If a customer asks for your advice on selecting emollients, it is important that you know how to help. Asking the WWHAM questions will enable you to determine what type of eczema the customer has and how it should be treated. Remember the products must be cosmetically acceptable to the customer (i.e. that they like the texture and format) as they will have to use them regularly for many years. You may also be able to help the customer identify possible triggers that make their eczema worse and suggest ways in which they can avoid these, such as avoiding itchy fabrics or certain detergents. Before selling a product, ask the customer the following: When to refer Refer to the pharmacist in the following instances: • If the skin shows signs of infection (e.g. weeping) • The customer’s eczema has suddenly got worse • There is associated fever, lethargy or distress • Have they tried any emollients before? If so, are they • When the eczema is severe. happy with it or would they like to try an alternative? • How are they using the emollients? If necessary, give advice on how to use them effectively. Pharmacy support staff should remember to complete the case study on page 14 and discuss their answers with the pharmacist. a training guide for the pharmacy 9 scaly scalp conditions What is dandruff ? What is seborrhoeic dermatitis ? Dandruff is a common scalp condition that is often seen This is a more severe condition that affects the scalp as in pharmacy. Whilst it may seem like a minor complaint, well as other parts of the body such as the eyebrow, nose, it can often make sufferers feel embarrassed due to the ears, face and forehead. The exact cause of seborrhoeic unpleasant symptoms and it can reduce their confidence. dermatitis is unknown but it may be due to a reaction to the fungus malassezia furfur. Dandruff is the build-up of dead cells on the scalp and it is estimated that one in four people in the UK will suffer from • It affects both men and women The symptoms of seborrhoeic dermatitis • It is most common in people’s 20s and 30s and can • White flakes of skin dandruff at some point in their lives. occur at any time. • Red and inflamed skin The skin cells are constantly being shed from the scalp as • Patches of red, scaly and greasy skin fine particles that go unnoticed. If a person has dandruff • Yellow brown crusts may form on top of these patches. these cells are shed more quickly than normal and clump together to form visible white flakes. It is quite common for babies to get seborrhoeic dermatitis on their scalp in the first few months of life and it is Dandruff is also linked to the presence of higher than referred to as cradle cap. normal levels of a fungal yeast (known as malassezia furfur) which skin cells are shed, as well causing skin irritation Treatments and inflammation. There is no cure for these scalp conditions but using on the scalp. This fungal yeast accelerates the rate at OTC treatments can help to reduce the symptoms. Your advice can also make a difference to customers activity Which products would you recommend to a customer who complains of a flaky and itchy scalp? Jot them down in the box below: and their condition. Recent research showed that customers wanted an anti-dandruff treatment which also relieved itching. There are several shampoos available containing one or more of the following active ingredients: • Ciclopirox olamine and ketoconazole are topical The symptoms of dandruff antifungal agents that work by killing the yeast on the • White flakes that fall out of the hair onto the shoulders or They also have anti-inflammatory properties to soothe can be seen in the hair • Intense itching and scratching • Red or inflamed scalp. 10 a training guide for the pharmacy scalp and so reduce the production of scalp cells. the soreness and reduce itchiness of the scalp • Salicylic acid helps to remove the dead skin cells from the scalp What are the symptoms of scalp psoriasis ? • Selenium sulphide reduces the natural oils produced by the scalp • Coal tar clears the scales and relieves itching • Itchy scalp and inflammation. • White flakes of skin Some products contain a combination of ingredients. For example, Oilatum Scalp Intensive Treatment Shampoo • Raised pink patches of skin on the scalp contains ciclopirox olamine and salicylic acid and is designed to eliminate stubborn white flakes, soothe sore • Silvery scales form on top of the patches scalps and provide relief from itching. • Especially noticeable around the hairline and ears. The aim of any treatment is to slow down the shedding of Customers with scalp psoriasis should be referred to the skin cells and to kill the fungus causing it. You should the pharmacist. encourage customers to use the product as directed on the packaging for effective treatment, and then subsequent Refer to the pharmacist management, of the scalp condition. • If the customer has severe scaling on the scalp and/or Scalp psoriasis on other parts of the body Scalp psoriasis is a long-term scalp condition. With this • Any customer who has used an antifungal shampoo condition the body produces skin cells up to six times and has experienced a burning, itching or stinging faster than normal, which can build up on the scalp. sensation Other parts of the body such as elbows and knees can • If the scalp appears to be infected (i.e. if it is weeping or also be affected by the overproduction of skin cells. open and red) It is a hereditary condition that most often appears • If they have symptoms of scalp psoriasis. between the ages of 10 and 30. activity Complete the following table. Product Main ingredients Mode of action Directions for use Oilatum Scalp Treatment Shampoo Oilatum Scalp Intensive Treatment Shampoo Selsun Shampoo Head and Shoulders Shampoo Polytar Liquid T-Gel Shampoo Others Pharmacy support staff should remember to complete the multiple choice questions (found on the flap attached to the back cover of this guide) and return them to receive their Certificate of Achievement. a training guide for the pharmacy 11 completing your cpd The following synopsis gives you an overview of the Clinimatrix study and the NICE guidelines. NICE guidance The National Institute for Health and Clinical Excellence Results from the Clinimatrix study: (NICE) recently issued new guidelines on the best way to The Clinimatrix study, funded by an educational grant from manage atopic eczema in children. Among its Stiefel and coordinated by Alison Carr (senior lecturer in recommendations, NICE advises that: Epidemiology at Nottingham University) and a team of community pharmacists, proved that pharmacy intervention • Healthcare professionals should offer children with atopic to promote effective use of emollients can increase the eczema a choice of unperfumed emollients to use every correct use and application of emollients and significantly day for moisturising, washing and bathing reduce symptoms. • Healthcare professionals should spend time educating The study in UK community pharmacies involving children with atopic eczema and their parents or carers 50 children with eczema found that: about atopic eczema and its treatment. • Fewer than five per cent of parents recalled receiving any The NICE guidance provides some interesting facts about demonstration of how to apply emollients how eczema affects children and the step up or down • Only six per cent of participants applied their emollient cream correctly approach treatment of eczema. • 88 per cent were incorrectly rubbing the cream in, which can cause further irritation and make the condition worse • 24 per cent of parents were confusing emollient creams with steroids and applying them sparingly instead of liberally. During the study, participants were seen by a pharmacist How atopic eczema affects children Skin severity Appearance Impact on life Clear Normal skin, no evidence of active atopic eczema No impact on quality of life Mild Areas of dry skin, infrequent itching. May or may not be small areas of redness Little impact on everyday activities, sleep or psychological wellbeing Moderate Areas of dry skin, frequent itching, redness with or without excoriation and skin thickening Moderate impact on everyday activities and psychological wellbeing Severe Widespread areas of dry skin, incessant itching, redness with or without excoriation, extensive skin thickening, bleeding, oozing, cracking and alteration of pigmentation Severe limitation of everyday activities and psychosocial functioning and nightly loss of sleep who reviewed their management of eczema and gave advice, practical tips and a demonstration of the correct way to apply topical emollients. They also discussed concerns and questions raised by the patients/parents and gave them written information about eczema and how to treat it. Despite the fact that each intervention took just 10 to 15 minutes, the results were impressive: • 44 per cent of subjects experienced a 50 per cent or greater reduction in itch and irritability • There was an increase in the number of subjects who applied emollient creams correctly, resulting in a significant reduction of symptoms. 12 a training guide for the pharmacy Review of treatment options for atopic eczema Remember to use this booklet as a CPD opportunity and log your CPD at www.uptodate.org.uk Systemic therapy Use the following CPD questions to help you get the most Phototherapy from this training: Bandages Bandages Topical calcineurin inhibitors Topical calcineurin inhibitors Mild potency topical corticosteroids Moderate potency topical corticosteroids Potent topical corticosteroids Emollients Emollients Emollients mild atopic eczema moderate atopic eczema severe atopic eczema reflect How does my pharmacy manage customers with eczema? Do I know the different treatments available for treating eczema? What anti-dandruff products are stocked in the pharmacy? plan RPSGB CPD competencies Do I need to improve my knowledge in the area of skin and scalp conditions? This pharmacy guide should provide an opportunity to engage in CPD and will contribute towards the following Which customers should I be targeting for advice on the management of eczema? RPSGB competencies: G1a Using expert knowledge and skills to benefit patients. act G1d Taking a patient centred approach. G2o Responding to requests for advice or information. What role can my pharmacy team play in educating G6f Teaching or training. customers about the management of eczema? C1f Providing advice and counselling. How can I demonstrate to my customers the correct use of emollients and other treatments? reflect Obtain the NICE guidelines (www.NICE.org.uk) and a copy of the Clinimatrix study (www.pjonline.com). The evaluate cpd cycle plan evaluate Do I need any further training on the management of skin and scalp conditions? act a training guide for the pharmacy 13 assessment case study A worried mum asks for your help in selecting a treatment that will help her five-year-old daughter to sleep better at night. She has atopic eczema and it has recently flared up. Use the WWHAM questions: Pharmacy support staff case study discussion points The following points should be discussed with your pharmacy support staff: • Customers should be encouraged to use a cream and a bath additive Who is the treatment for? • Effective cream application and use of bath You know that the treatment is for a child. additive What are the symptoms? The customer tells you that her daughter has very dry, red skin – particularly on the back of her knees, elbows and wrists. The symptoms have flared up and are now so troublesome that her daughter is finding it very difficult to stop scratching at night, which means she is not sleeping well. This is disrupting the whole family’s sleep. How long have the symptoms been present? She has been prone to eczema since she was a baby, but this particular flare-up has been present for three days. • Apply to the whole body using 250-500g of cream per week • Use the cream frequently throughout the day – encourage the child to take a small tub of cream to school and use it when the eczema is itchy • Use of steroids during a flare-up • To go to the doctor if the emollients do not Action already taken? The customer has tried rubbing moisturising cream into the affected areas of her daughter’s skin, but this only seems to be making matters worse. She was given some treatment but has not used it for several months. Medicines taken for other reasons? soothe the dry and itchy skin • The emollients should be used all the time and also when using other treatments • Discuss the trigger factors and ways to avoid them. The little girl is taking occasional antihistamine syrup for hayfever. Training action points action What product/s would you recommend? Do you think the customer is aware of how emollients should be applied? What other advice could you offer? Discuss your answers with the pharmacist. • All intertext exercises and the case study should be completed, discussing the answers with the pharmacist • The multiple choice questions should be completed and returned to receive a Certificate of Achievement • Pharmacists and registered technicians should record their CPD onto the RPSGB website. 14 a training guide for the pharmacy This page is not covered by the NPA Training Seal. Oilatum products guide Oilatum Bath Formula Oilatum Junior Cream 150g & 500ml Prescribing Information Active Ingredients: light liquid paraffin 6.0% w/w and white soft paraffin 15.0% w/w. Uses: For the treatment of atopic eczema, contact dermatitis and dry, sensitive skin including icthyosis. Dosage and administration: Apply topically to the affected area and rub in well, may be used as often as required. It is especially effective after washing. Side effects, precautions and contraindications: Should not be used in patients with known hypersensitivity to any of the ingredients. Hospital users should follow local procedures and policies for using topical products on in-patients. Keep out of the sight and reach of children. Consult the SPC for further details. Legal category: GSL. Package quantities & NHS price: 150g £3.38, 350g £4.65, 500ml £6.35, 1050ml £14.67. Product Licence number: PL 0174/0207 (150g) PL 0174/0219 (350g, 500ml, 1050ml). Marketing Authorisation Holder: Stiefel Laboratories (UK) Ltd. Holtspur Lane, Wooburn Green, High Wycombe, Bucks, HP10 0AU, UK. Date of preparation: November 2008. Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk. Adverse events should also be reported to Stiefel Laboratories (UK) Ltd at [email protected]. Oilatum Scalp Treatment Oilatum Junior Bath Prescribing Information Active ingredients: light liquid paraffin 63.4% w/w. Uses: For the treatment of contact dermatitis, atopic dermatitis, ichthyosis and related dry skin conditions. Oilatum Junior Emollient Bath Additive is particularly suitable for infant bathing. Dosage and administration: Suitable for use in infants and children. Oilatum Junior Emollient Bath Additive should always be used with water, either added to the water or applied to wet skin, and may be used as frequently as necessary. Add 1-3 capfuls to an 8-inch bath of water, soak for 10-20 minutes, and pat dry. Infant bath: Add 1-2 capfuls to a basin of water, apply gently over entire body with a sponge, and pat dry. Side effects, precautions and contraindications: Take care to avoid slipping in the bath. If a rash or skin irritation occurs, stop using the product and consult with the doctor. Consult the SPC for further details. Legal category: GSL. Package quantities & NHS price: 150ml £2.82, 250ml £3.25, 300ml £5.10 and 500ml £5.75. Product Licence number: PL 0174/0182. Marketing Authorisation Holder: Stiefel Laboratories (UK) Ltd. Holtspur Lane, Wooburn Green, High Wycombe, Bucks, HP10 0AU, UK. Date of preparation: November 2008. Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk. Adverse events should also be reported to Stiefel Laboratories (UK) Ltd at [email protected]. Oilatum Scalp Intensive Oilatum Gel Prescribing Information Active Ingredients: light liquid paraffin 70% w/w. Uses: For the treatment of contact dermatitis, atopic dermatitis, senile pruritus, ichthyosis and related dry skin conditions. Dosage and administration: Oilatum Gel may be used as frequently as necessary. Oilatum Gel should be applied to wet skin, normally as a shower gel. Shower as usual. Apply Oilatum Gel liberally to wet skin and massage gently. Rinse briefly and lightly pat the skin dry. Side effects, precautions and contraindications: Take care to avoid slipping in the shower. Oilatum Gel should not be used on greasy skin. Keep out of the sight and reach of children. Consult the SPC for further details. Legal category: GSL. Package quantities & NHS price: 150g £5.15. Product Licence number: PL 0174/0072. Marketing Authorisation Holder: Stiefel Laboratories (UK) Ltd. Holtspur Lane, Wooburn Green, High Wycombe, Bucks, HP10 0AU, UK. Date of preparation: September 2008. Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk. Adverse events should also be reported to Stiefel Laboratories (UK) Ltd at [email protected]. 1. References are available on request. a training guide for the pharmacy 15 eczema and scalp conditions Test your knowledge eczema and scalp conditions Test your knowledge Remember to complete and return Remember to complete and return your multiple choice questions to your multiple choice questions to ensure that you receive your ensure that you receive your Certificate of Achievement. Simply tick one correct Certificate of Achievement. Simply tick one correct answer for each of the questions below. answer for each of the questions below. You can photocopy this form before completion for You can photocopy this form before completion for other members of staff to use. Either fax your other members of staff to use. Either fax your answers to: 01284 717699 or detach the card and answers to: 01284 717699 or detach the card and post it back using the reply paid service. post it back using the reply paid service. 1. Atopic eczema occurs as: a. Dry and itchy skin b. Flaking skin c. Split skin d. Spotty skin 1. Atopic eczema occurs as: a. Dry and itchy skin b. Flaking skin c. Split skin d. Spotty skin 2. Emollients work by: a. Numbing the skin b. Providing an oily layer over the skin c. Reducing inflammation d. Helping to heal the skin 3. The following advice should be given to customers: a. Apply emollients to the affected parts of the body only b. Apply emollients infrequently c. Smoothe emollients onto the skin d. Rub in the emollients 4. How much emollient cream should be applied each week? a. 0.25-0.5g b. 5g c. 50g d. 250-500g 5. Dandruff can be caused by: a. Scratching the scalp b. Build-up of hair products on the scalp c. Above normal levels of fungal yeast d. Above normal levels of bacteria 6. Scalp psoriasis is: a. Caused by bacteria b. Caused by fungus c. Hereditary d. Caused by not washing the hair Name: Job title: 2. Emollients work by: a. Numbing the skin b. Providing an oily layer over the skin c. Reducing inflammation d. Helping to heal the skin 3. The following advice should be given to customers: a. Apply emollients to the affected parts of the body only b. Apply emollients infrequently c. Smoothe emollients onto the skin d. Rub in the emollients 4. How much emollient cream should be applied each week? a. 0.25-0.5g b. 5g c. 50g d. 250-500g 5. Dandruff can be caused by: a. Scratching the scalp b. Build-up of hair products on the scalp c. Above normal levels of fungal yeast d. Above normal levels of bacteria 6. Scalp psoriasis is: a. Caused by bacteria b. Caused by fungus c. Hereditary d. Caused by not washing the hair Name: Pharmacy name: Pharmacy name: Address: Address: Postcode: Job title: Postcode: Daytime telephone number: Daytime telephone number: For any queries, call 01284 717682 For any queries, call 01284 717682 BUSINESS REPLY SERVICE LICENCE No RRHA-UXZU-HURY BUSINESS REPLY SERVICE LICENCE No RRHA-UXZU-HURY Precision House Bury Road Beyton BURY ST EDMUNDS IP30 9PP Eczema & Scalp Conditions Precision House Bury Road Beyton BURY ST EDMUNDS IP30 9PP Eczema & Scalp Conditions
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