Rx Note

Introduction Miliaria, also known as heat rash, sweat rash or prickly heat, is a common skin disease caused by blockage and/or inflammation of eccrine sweat ducts. The blockage leads to backflow of eccrine sweat into the dermis or epidermis, resulting in a rash comprised of sweat-filled vesicles under the skin. The type of miliaria that develops depends on the depth at which the duct is blocked. Miliria crystallina - Occurs when the duct is blocked superficially, within or close to the stratum corneum. Miliaria rubra - The most common type; occurs when the duct is blocked deeper within the epidermis. Miliaria profunda - Occurs when the eccrine duct is blocked at or below the epidermal-dermal junction. Common triggers include hot and humid environments (especially shortly after moving to a tropical climate), strenuous physical activity, febrile illness and occlusion of the skin. Management The rash is usually self-limited and resolves without medical intervention. The primary treat...

Introduction Soap-free products have gained popularity among people with dry or sensitive skin due to their milder nature and pH-balanced formula. pH and Skin Biology pH is a measure of how acidic or alkaline a substance is. It ranges from 0 to 14, with 7 being neutral. Normal skin pH ranges from 4.1 to 5.8 , which means it is slightly acidic. It varies according to Different part of body Different age - Newborns have a higher skin pH than adults, ranging from 6.34 to 7.5, depending on the anatomical site. Different races Exogenous factor (e.g. soap, detergents, leave on products) The acidic pH of the stratum corneum (the outermost layer of the skin) is crucial for skin barrier function (preventing transepidermal water loss and dehydration) and provide an antimicrobial barrier by preventing colonization (e.g. by Staphylococcus aureus and Malassezia ). Inflammatory skin diseases, such as atopic dermatitis and irritant contact dermatitis, are associated with an increased skin pH and...

Introduction Unlike internal medicine, most dermatological complaints presenting in a community pharmacy can be seen (and felt). This presents the community pharmacist an excellent opportunity to base the differential diagnosis by Questioning Where did the problem first appear? Are there any other symptoms? Itch and/or pain? Family and household contact history The patient's thoughts on the cause of the problem Physical examination It is worth remembering that many patients will be embarrassed by the appearance of the skin conditions. Examples of notable findings include: Dry, flaky scalp with reddened areas may indicate dandruff , psoriasis or dermatitis . White patches on the tongue or throughout the mouth can indicate oral candidiasis ("thrush"). Xanthomas are deposits of cholesterol in the skin of patients who have very high cholesterol levels and indicate a need for referral. Nails that are very thick, lifting up from the nail bed or are discoloured can be a sign o...

Introduction Acanthosis nigricans is a skin disorder characterized by darkening (hyperpigmentation) and thickening (hyperkeratosis) of the skin, occurring mainly in the folds of the skin in the armpit, groin and back of the neck. The patches often appear gradually without any other symptoms. Sometimes the skin may be itchy. Aetiology Most, if not all, patients with acanthosis nigricans have one of the following categories of disorders. Obesity Endocrine and metabolic disorders, particularly disorders associated with insulin resistance Genetic syndromes with acanthosis nigricans Familial acanthosis nigricans Malignancy Drug reactions Examples: systemic glucocorticoids, injected insulin, oral contraceptives, niacin, protease inhibitors, palifermin, testosterone, aripiprazole. NOTE: Although acanthosis nigricans is usually harmless, the prognosis for patients with malignant acanthosis nigricans is often poor since malignancy is frequently diagnosed at an advanced stage. Management Sin...

Introduction Eczematous cheilitis, also known as lip dermatitis, is inflammation of the lips presenting as redness with dryness and scaling. The major causes of eczematous cheilitis are atopic dermatitis and irritant or allergic contact reactions . Symptoms Unlike simple dry lips, eczematous cheilitis is significantly more severe. The lips are typically intensely chapped, and may also be inflamed and scaly. Different from angular cheilitis , eczematous cheilitis typically involves the whole lips and surrounding skin. Management Treatment will depend on the cause. Where an exogenous cause has been identified, this should be avoided if possible . Excessive lip licking Lipsticks and other lip care products that contain fragrances or dyes Toothpaste or mouthwash - Avoid alcohol or harsh antiseptics Plastic bottles/cups (opt for glass or metal) Dental materials Stress Specific foods Medications Moisturisers (e.g. petroleum jelly) and topical corticosteroids may be recommended for atop...

Introduction Infantile haemangioma (also known as strawberry naevus) is a common benign vascular tumour that affects up to 10% of neonates. It is more common in females and in premature infants. Symptoms The lesion may be present at birth, or appear within the first month of life. It may initially present as a faint pink or red patch on the skin, often mistaken for a scratch. The mark may then grow and evolve into the more typical prominent red lump. Infantile haemangiomas can be Superficial (50-60%) - Typically has a sharp border, and is a round or oval with a smooth or slightly bump surface Deep (15%) - Develops under the skin and may appear as a slow-glowing skin-coloured or slightly blue lump. Mixed (25-35%) The majority of infantile haemangiomas reach their final size when the child reaches 3 months of age , but some may continue to grow until the child is 5 to 9 months old. The lesion then enters a slow involution phase (shrinking phase) , which can take several years. After s...

Introduction A skin lesion is a part of the skin that has an abnormal growth or appearance compared to the skin around it. Common benign skin lesions have typical clinical characteristics and appearances . Certain lesions, such as nevi, milia, dermatofibroma, skin tags, pyogenic granuloma, keratosis pilaris, syringoma are more common in children and younger adults. Some lesions such as seborrheic keratosis, sebaceous hyperplasia, solar lentigo, cherry angioma, large cell acanthoma, venous lake, ganglion, epidermal inclusion cysts, and lipoma are more likely to present in middle-aged to older adults. Benign lesions that are symptomatic or cosmetically bothersome can often be managed with simple procedures such as cryotherapy, electrosurgery or excision. ABCDE Criteria All skin lesions should be assessed for signs that may suggest malignancy such as newly changing appearance or any positive ABCDE criteria. A - Asymmetry B - Border irregularities C - Colour variation (mottled, shades of...

Introduction Melasma (also referred to as chloasma or mask of pregnancy) is a persistent and recurring skin condition that is difficult to treat. It results from excessive production of melanin by melanocytes in the skin. It usually presents as light-brown to grey-brown macules and patches on sun-exposed skin. Lesion are usually symmetric and may affect the forehead, nose, cheeks, upper lip area and chin. It is typically seen in women of childbearing age but may also occur in men. NOTE: Given its frequent facial involvement, melasma can significantly affect patients' quality of life. Main Risk and Trigger Factors Genetic predisposition Exposure to sunlight Skin phototypes (mainly darker skin types) Hormonal factors (including pregnancy, hormonal therapies and oral contraceptives) Management Management can often be challenging as it often results in incomplete response and frequent relapses. In most cases, a multimodality approach is required based on the patient's charact...

Introduction Ichthyosis vulgaris (sometimes called "fish scale disease" or "fish skin disease") is characterised by excessive dry, scaly skin. It is the most common form of the inherited ichthyosis. Results from loss-of-function mutations in the gene encoding the protein filaggrin (FLG). Some patients may "acquire" ichthyosis vulgaris because of a medical illness (e.g. kidney failure, leprosy, human immunodeficiency virus) or in response to a medication (e.g. cimetidine, clofazimine). Clinical Features The main feature of ichthyosis vulgaris is dry, thick and scaly skin. In ichthyosis vulgaris, skin cells reproduce at a normal rate, but they do not separate at the skin's surface, as they normally do. Also, dead skin cells do not shed quickly enough, causing a buildup of scales. The condition is usually not present at birth. Most often it appears after about 2 months and in most cases before the age of 5. Symptoms may worsen up to puberty, and sometimes...