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With skin being our largest organ and having many vital functions, it’s important to maintain skin health to prevent Aissues that can lead to aggravation, infection and longer-term problems. This month Retail Pharmacy Assistants magazine explores the complex area of skin health, specifically looking at how to manage this in children. ccording to Melbourne \\\[as a result of\\\] inappropriate sunscreen off in the shop, in a pram – so be it,” he Consultant Dermatologist being used”. said. “But you cannot possibly help a Cara McDonald, “our skin But he underscores that it’s the severe nappy rash \\\[for example\\\] unless is a big deal, literally”. responsibility of pharmacy staff “to you see what’s going on.” In an article titled ‘The skin is a very see the skin” before making In terms of making recommendations, Mr important (and our largest) organ: what does it do?’1, she wrote: “It’s the largest organ in the body and one of the most complicated. It has many roles in the maintenance of life and health, but also has many potential problems, with more than 3000 possible skin disorders.” Some of these skin disorders occur in children, and proper and effective management is needed to prevent possible infection, worsening of the condition and ongoing issues. Community Pharmacist and Master Herbalist Gerald Quigley says typical skin ailments seen in pharmacy among children include “eczema and dermatitis, dry skin issues, sometimes burns, \\\[and\\\] hives”. Brisbane Dermatologist Dr Leon Yip agrees, citing the four common skin conditions that affect children: “eczema, nappy rash, heat rash and sunburn”. “Eczema tends to be a genetic tendency ... which causes dry skin and lack of skin oils – mainly ceramides, fatty acids and cholesterol that act like glue on the skin and stick the skin cells together,” she said. “And because this glue doesn’t work properly, you get more water loss into the environment. The skin gets more irritated and drier, and therefore it’s more prone to inflammation. “The second component of eczema is immune system-driven inflammation. A lot of people, unfortunately, don’t use optimal treatments: proper moisturisers and anti-inflammatory treatments, such as topical steroids, that can help control the eczema. Therefore, the skin can get aggravated because of that.” Dr Yip says eczema can be aggravated by environmental issues such as house dust mites, while pollens, grass and animal fur can cause allergic reactions. It’s evident the skin is a large and complex organ. Mr Quigley points out that the causes of the common conditions are “really varied, going from poor choice of bath and moisturising products, to hives appearing when new foods are introduced into a child’s diet, to sunburn recommendations as to treatment options – “because sometimes mums present on the basis of what social media has advised, or Grandma or some well-meaning person who \\\[has provided advice\\\] without even looking at the skin”. “So, it’s very important that if you’re going to offer some support, you have to actually see the skin” Mr Quigley said. “Have a look at the skin structure, texture and colour – as in tanned skin or fair skin or freckled skin. You’ve got to really have a look at the whole thing, because every single presentation will be different. I can’t stress that enough.” While the previously mentioned skin conditions are common and have varied causes, Mr Quigley says they are typically “caused by something that disrupts the barrier between the internal and external environment”. “Remember, the skin protects our body, at whatever age, from mechanical damage, radiation, noxious substances, invasion by germs,” he said. “So, as well as keeping or reducing the risk of water loss, which keeps homeostasis ... and regulates body temperature, \\\[the skin\\\] also plays a role in immune function.” Adding to the list of skin’s functions, Mr Quigley says skin also “plays a vital role in how you feel and how you look”. “All these things are very important, and by looking at the skin, it gives you a bit of an idea,” he said, adding that some simple questions should be asked: ‘How long has the problem been there?’ ‘Did it arise slowly or suddenly?’ ‘What do you think is an underlying cause?’ ‘Has there been any health issues in the past little while that might have caused something like this to have cropped up?’ He says elementary history taking is important, although in pharmacy this doesn’t usually happen because the interaction with the customer is too brief. Of course, gaining the customer’s permission is important, too, and Mr Quigley suggests simply asking: ‘Do you mind if I have a look at it \\\[the skin problem\\\]?’ “So, this might mean taking a nappy Quigley warns against “rushing treatment”. “These things are common,” he said. “Many of them will resolve provided you keep an eye on them. So, it’s important not to rush treatment.” He continued: “Certainly, have something checked out, but don’t necessarily expect the worst just because of some imperfection that’s arrived on a child’s skin, particularly a baby’s skin.” Kids: assessment then management “You have to assess the person’s overall health for a start,” Mr Quigley said when asked about the best way to manage skin conditions in children. “So, \\\[an infant\\\] that’s 12 months old is going to have food selected by the parents, \\\[whereas\\\] a \\\[teenager\\\] at 17 is going to be eating every bit of \\\[less healthy food\\\] under the sun,” he said. “Getting a bit of an idea of where that person is, from a lifestyle perspective, \\\[is important\\\]. If they’re a teenager \\\[ask\\\] whether they’re stressed at school, whether they just have the wrong nutritional options, whether they shower regularly.” Once the skin has been viewed and questions asked about the person’s lifestyle and history, Mr Quigley says the fundamental steps in looking after the skin are cleansing and moisturising, “because that keeps the \\\[skin\\\] barrier nice and structured”. “So, if we’re looking at younger kids ... you’ve got to be guided by the best cleansing and the best moisturising products,” he said. “You’ve got to be guided by the pharmacist, who’ll have an understanding of the skin’s pH and how to maintain that, and also \\\[what\\\] the best \\\[options are for\\\] moisturising.” Mr Quigley also underscores the importance, as a pharmacy assistant, of “clearly understanding the role of the cleanser and the moisturiser, and what they’re supposed to do and how frequently they’re to be applied”. Dr Yip adds that, particularly when it comes to eczema, “avoiding irritants such TO PAGE 42 RETAIL PHARMACY ASSISTANTS • FEB 2021 SKIN MATTERS 41