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cysts and nodules, needs GP attention and potentially systemic treatments,” Mr Narsey said. He emphasises, though, that acne treatment isn’t just about topical therapies, but also a grasp of what’s going on with the patient’s hormones and what factors are causing disturbances. He adds that it’s also about understanding the gut and determining if an intestinal obstruction is present. This necessitates asking the patient questions, including those related to diet, to establish, for example, their level of dairy consumption, which may be excessive. “This is because gut imbalances can be related to hormonal issues with the skin,” Mr Narsey said. “This is missed by a lot of people.” The pharmacy specialises in dealing with leaky gut syndrome, so it’s not new to gut issues. “This really assists our many patients who suffer from reflux indigestion, which means they’re unable to \[properly\] digest their food,” Mr Narsey said. “They’re typically prescribed medications that only treat the symptoms. We know we have to treat the symptoms, but also work on healing the gut.” The pharmacy often treats these patients with prebiotics for a couple of weeks, followed by a “safe” preparation of curcumin in turmeric, aloe vera, glutamine and magnesium, then with probiotics. The treatment protocol is tailored to the individual because the stomachs of some patients are sensitive to certain ingredients, he says. “There may be ingredients and medications some patients need to avoid in the overriding quest to recolonise their gut and eliminate holes or cracks that allow bacteria, toxins, antigens and partially digested food to penetrate the tissues beneath it that trigger inflammation and changes in the gut flora or normal bacteria,” Mr Narsey said. This holistic approach is in line with Mr Narsey’s belief that wellness is attained through a combination of natural medicines and pharmacotherapy. “We always try to take a holistic approach and help our patients gain more understanding of their condition, including through social media,” he said. “We try to spend those extra seconds asking them a question to facilitate understanding, and therefore prevent them merely finding a quick solution then running away.” As to patients with PCOS, Mr Narsey points out that no matter how many surface treatments they use to get rid of acne, they won’t make progress until they grasp the underlying issues that cause the imbalance. He adds that, at times, the patient is called on to take charge through having a full blood panel test administered by a GP, nurse or other suitably trained person. “People are usually concerned with the aesthetic or cosmetic side, but the fact remains that hormonal imbalances carry metabolic risk, which can result in problem periods, leading to irregular ovulation and other consequences, including infertility,” Mr Narsey said. inactivates testosterone, which causes acne. “Typically, therefore, we use birth control hormones to control the skin, which is right for many women in certain situations,” Mr Narsey said. Exceptions to the rule are when a woman is using a contraceptive that contains only progestin or is habituating her body to a new contraceptive, because progestin results in an increase of testosterone in the body. Mr Narsey points out that the prescribing of contraceptives is the responsibility of GPs, as this is out of the pharmacist’s scope. “If contraception is being used for acne, a blood panel with hormonal levels is required,” he said. During periods, hormones such as testosterone and cortisol can cause a hike in oil production, whereas estrogen keeps it under control, Mr Narsey says. He adds that in the second phase of the menstrual cycle, though, estrogen levels decrease, resulting in an imbalance that can affect the skin. The pharmacy advises patients suffering from hormonal acnes to manage their stress, exercise regularly and eat healthily. “A contraceptive and probiotics can be taken in tandem with lifestyle awareness,” he said. “The main thing is probiotics – and fish oil, depending on the patient.” Mark Webster, owner of Stay Well Pharmacy in Christchurch, New Zealand, says he encounters many patients dealing with hormone-impacted skin. “The skin is the largest organ in the body, so it stands to reason that if we have an imbalance or destruction of our health somewhere it will show up on our skin,” he said. To assist patients, Mr Webster says he looks in depth at their medical history. “I guess the fundamentals are focused on how inflammation can be reduced and how the skin can be fed based on a patient history and questions,” he said. “And then it’s all about providing relief to the patient.” He points out that some conditions, such as acne or rosacea, are extremely difficult to treat. “Even with conventional medicines they can take months to treat,” he said. “Usually by the time I see someone, they’re at their wits end. So it’s also about keeping the patient encouraged to keep on doing what they’re doing.” SKIN FIX 59 “The skin is the largest organ in the body, so it stands to reason that if we have an imbalance or destruction of our health somewhere it will show up on our skin.” “So, we’re on the lookout for acne and irregular periods, and try to get an understanding of a patient’s diet and what’s going on with them. “At times we do recommend OTC supplements and have protocols for gut problems, but at the end of the day there’s no substitute for seeing a GP.” Mr Narsey says stress can have a significant impact on the skin in the form of a rash, blotches or large breakouts. This is because an increase in cortisol, often called the ‘stress hormone’, puts the sebaceous glands into overdrive, resulting in too much acne-causing sebum. “Simply put, it’s too much oil in the pores, resulting in pore clogging and acne,” he said. Anxiety and depression may also be linked to high cortisol levels, which can contribute to, among other things, changes in a woman’s menstrual cycle and sex drive. Impact of contraceptives and periods Birth control can improve a woman’s skin because estrogen, which is contained in many contraceptives, RETAIL PHARMACY ASSISTANTS • JUN 2020