Self-Care for Skin Health

Case 1: Wound Care

Q: RG, a 26-year-old woman, comes to the pharmacy seeking something with which to treat a burn. She was cooking and accidentally touched her arm on a pan. The burn is pink and approximately 1 inch in diameter, with unraised edges and without blisters. The burn occurred approximately 40 minutes ago, after which RG immediately put her arm under cold water for about 15 minutes. Then she came to the pharmacy for treatment options. Otherwise, she reports feeling well and does not have any medical problems or allergies to medications. What recommendations do you have for RG?

A: Minor burns can be treated with OTC products. Because RG already put her arm under cold water, she can proceed with gently cleaning the burn area with water and a mild soap. The wound should be kept moist to foster healing. Drying the wound can lead to scabbing and delay healing. RG should avoid touching the area to prevent infection. To keep the area moist, she can apply a skin protectant ointment such as petrolatum or a topical anesthetic, which would also reduce the pain. Then she can apply a transparent film dressing to provide additional protection for the wound. If blisters were present, she could use a hydrocolloid dressing to protect the blister and prevent infection. She should be advised to see her primary care provider (PCP) if the burn worsens or does not heal within 7 days.¹

Case 2: Mosquito BiteQ: DF, a 28-year-old woman, visits the pharmacy because she will be traveling to South America for work and is concerned about the Zika virus. She would like to be as prepared as possible prior to the trip. She is looking for OTC products to prevent mosquito bites. DF is healthy and does not have any medical problems or allergies to medications. What recommendations do you have for her?

A: The most effective way to prevent a Zika infection is to avoid geographic regions with the virus. Because DF must go on her trip, her next best preventive options are protection from mosquito bites and from genital secretions of sexual intercourse partners. DF should try to wear long sleeves and pants when possible, especially when outdoors.² In addition, she can use an insect repellent that contains N,N-diethyl-m-toluamide, also known as DEET. Before she goes outdoors, she should apply it to uncovered skin, over her sunblock, avoiding application near her eyes. It is important to instruct DF to wash the application sites with soap and water when she goes indoors.³ Sexual transmission of Zika can be prevented by using condoms or avoiding sex with individuals who have been infected. DF should be educated to seek immediate evaluation by a PCP if she develops flu-like symptoms, fever, or rash. Because DF will be traveling internationally, she should also be evaluated for travel vaccinations and malaria prophylaxis, depending on the regions she will be visiting.

Case 3: WartsQ: HU, an 18-year-old man, comes seeking a wart treatment. The wart, on his hand, appears dome-shaped, brown, and rough. It appeared after HU started his new job as a lifeguard. He has not tried treatment with an OTC product. He is healthy and has no medical conditions. What recommendations do you have for HU?

A: HU appears to have a common wart, treatable with salicylic acid. Any of the numerous OTC products containing salicylic acid 15% to 40% can be used. Many warts resolve without treatment, so HU should be given the option of waiting before using an OTC therapy. Patients who have diabetes or poor circulation or are immunocompromised should be referred to their PCP. OTC cryotherapy has been FDA-approved for warts; however, most studies show that it is not more effective than salicylic acid.⁴ HU should follow the package instructions, which vary by product. HU should follow up with his PCP in the following cases: if the wart reappears despite therapy; if it has not resolved after 12 weeks of treatment; if HU suspects infection; or if the wart is painful.

Case 4: Diaper DermatitisQ: GG’s daughter, BG, is 6 months old, and GG wants a diaper-rash remedy for her. BG’s rash is red and shiny. Recently, BG has been sleeping through the night; however, last night, she had a bowel movement in her sleep and awoke with a diaper rash, which she has never had before. GG is confused by the variety of OTC products available, and wants to know if one product works better than the others. What recommendations do you have for GG?

A: GG should be educated that prevention is the best way to avoid diaper rash. Occlusion and moisture with friction typically cause rash. Therefore, increasing the frequency of diaper changes is important. Ideally, changing BG’s diaper as soon as she urinates or defecates is ideal. Because BG already has a rash, GG should avoid using wipes that have alcohol, perfumes, or soaps, which can cause a rash to worsen or sting. To clean the area, GG should use water, if possible, and gently rub or pat the affected area. In addition, she can use an OTC protectant. The 17 FDA-approved products for treating diaper rash are allantoin, calamine, cocoa butter, cod liver oil, colloidal oatmeal, dimethicone, glycerin, hard fat, kaolin, lanolin, mineral oil, petrolatum, topical cornstarch, white petrolatum, zinc acetate, zinc carbonate, and zinc oxide.⁵ Most commercial products contain a combination of these ingredients. There are no comparative studies of OTC products; however, most contain zinc oxide and petrolatum. GG can use any of the FDA-approved products but should avoid those containing topical antibiotics or antifungals.

Dr. Mansukhani is a clinical associate professor at the Ernest Mario School of Pharmacy, Rutgers University, and a transitions-of-care clinical pharmacist at Morristown Medical Center in Morristown, New Jersey.Dr. Bridgeman is a clinical associate professor at the Ernest Mario School of Pharmacy, Rutgers University, and an internal medicine clinical pharmacist at Robert Wood Johnson University Hospital in New Brunswick, New Jersey.

References

• Bernard DB. Minor burns, sunburn, and wounds. In: Krinsky DL, Ferreri SP, Hemstreet B, et al, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 18th ed. Washington, DC: American Pharmacists Association; 2015:chapter 40.
• Protect yourself & others. CDC website. https://www.cdc.gov/zika/prevention/protect-yourself-and-others.html Updated April 5, 2017. Accessed April 17, 2017.
• Fight the bite for protection from malaria: guidelines for DEET insect repellent use. CDC website. https://stacks.cdc.gov/view/cdc/27947#. Published April 22, 2004. Updated. Accessed March 20, 2017.
• Adkins DM. Warts. In: Krinsky DL, Ferreri SP, Hemstreet B, et al, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 18th ed. Washington, DC: American Pharmacists Association; 2015:chapter 42.
• Beltrani VS, Bernstein IL, Cohen DE, et al. Contact dermatitis: a practice parameter. Ann Allergy Asthma Immunol. 2006;97:S1-S38.