OTC Case Studies (May 2015)
Even though it may not appear as such, mild allergic reactions may cause a rash.
Case 1: Lens Care
LG is a 28-year-old female who comes to your pharmacy complaining that her eyes have been feeling very dry lately when she wears contacts. She says she started a new job about a month ago that requires her to be on a boat for hours. Typically, it is very windy, which dries out her contacts very quickly. She tries to protect her eyes, but her contacts still feel very dry. When she wears her prescription eyeglasses, she feels a lot better; however, she states she does not want to wear glasses on a regular basis. She has been using lubrication eyedrops, but she needs to remove her contacts each time she wants to use the drops. She wants to know if she can use anything with her contacts to help prevent dryness. She is currently using Opti-Free Express as her contact lens solution. What recommendations do you have for LG?
Ideally, LG should wear her glasses since her eyes feel better with them, but since she does not want to do so, we recommend rewetting drops that can be used instead of lubricant eyedrops when her contacts are in place. Most lubricant eyedrops require patients to remove their contacts prior to use; however, rewetting solutions are recommended for use with contact lenses. Since LG already uses Opti-Free products, she can use Opti-Free Pure Moist rewetting drops.1 She should use these drops a few times each day, prior to her eyes feeling dry.
In addition, it may be helpful for LG to start using Opti-Free Pure Moist contact lens solution, which contains HydraGlyde Moisture Matrix.1 This will help her lenses stay moisturized overnight. LG should also be educated on general lens care. Since she is on a boat during the day, she should wash her hands before she uses her rewetting drops and should avoid touching or contaminating the tip of the eyedropper.
Case 2: Dry Eyes
WX is a 34-year-old woman complaining of weak eyes. She states that her eyes are typically dry in the winter, but they have felt awful and tired for the past 3 weeks. . She says she wears contacts for 8 hours a day during work and has not really changed anything in the past few weeks related to medications; however, she states she is constantly on her new cell phone to look up information and surf the web. She also works as a case processor and is on the computer all day. She wants to see if you have any recommendations on what could help her eyes feel less tired.
WX is suffering from dry eyes, which is common during winter. WX should be educated that nonpharmacologic interventions, such as using a humidifier, could be beneficial. Other nonpharmacologic measures include warm compresses, avoiding computer screens, and wearing protective eye devices. Since her job requires her to use a computer during the day, she may also have to try other nonpharmacologic measures.
In addition, she may benefit from ophthalmic lubricants, such as Soothe, Systane, Teargen II, Tears Naturale, and Gen Teal Lubricant Eye Gel. Typically, these products are available in eyedrops and/or eye ointments. Drops are used during the day, and gels are typically reserved for move severe cases and overnight therapies. Many patients complain of blurred vision when using the eye ointments; therefore, administering them prior to bed can help avoid blurred vision. Ointments can be used during the day if preferred, but patients should be educated on proper use and adverse effects.
WX should be educated to use her drops once or twice per day for mildly dry eyes. For severely dry eyes, a patient can increase the use of drops to 3 or 4 times daily. Preservative-free products are available and may be preferred in these severe cases. WX should also be educated to avoid using her cell phone to surf the web. Since her cell phone is the single change that has occurred, her eyes may improve if she avoids using it so much.
CASE 3: INFANT ECZEMA
LR is a 25-year-old woman who comes to the pharmacy looking to treat her baby’s rash. Her daughter, NM, is 9 months of age and just started eating solid foods. LR first introduced NM to various fruits; however, today she tried a new vegetable. NM suffers from eczema and has always had a rash around her face and fingers. This morning, that rash, which does not appear to look like an allergic reaction, spread all over her body. NM’s pediatrician had recommended a specific lotion for NM when the rash was on her fingers, but LR does not remember the name of it. Now that the rash has spread, what recommendations do you have for LR?
Since NM is being introduced to new foods, she could be having an allergic reaction. Even though it may not appear as such, mild allergic reactions may cause a rash. When treating atopic dermatitis or dry skin, patients should be excluded from self-treatment if they have moderate to severe conditions with intense pruritus; have involvement of large areas of the body, the face, or intertriginous areas; are younger than 1 year; or have skin that appears to be infected. Since NM is younger than 1 year and a large portion of her body is affected, it may be wise to refer her to the pediatrician for an evaluation. Once the rash is identified as eczema and NM is older than 1 year, petrolatum-containing products, colloidal products, and urea-containing products could be recommended depending on symptoms and age. LR should also be educated that hydration of NM’s skin is important since she suffers from eczema. She should also look for and try to avoid triggers that cause NM’s skin to worsen.
CASE 4: DRY SKIN
JW is a 48-year-old woman who comes to your pharmacy complaining of dry skin. She states that although her skin normally gets dry in the winter, this year has been a lot worse and her skin feels dry and itchy. She was so itchy, someone recommended hydrocortisone 1% cream; however, it did not help her. She also suffers from type 2 diabetes mellitus (T2DM) and is currently taking 1000 mg of metformin twice daily. She says her T2DM is in control and denies any allergies to medications. She states she typically takes 20- to 35-minute showers and likes the water to be hot. She does not use lotion regularly, but will use it sometimes in the summer when she wears dresses. Her diet is normal, she drinks 2 glasses of water a day, and nothing has changed recently, except the weather. She wants to know if there is anything you recommend for dry skin.
JW is clearly suffering from dry skin. She should stop using the hydrocortisone cream since it does not help. Instead, she can add a product, such as oilated oatmeal, near the end of a bath to help skin hydration until her skin improves. She should also apply an oil-based emollient immediately after bathing. JW should be educated on nonpharmacologic measures, such as avoiding excessively long showers. She should take 3- to 5-minute baths in tepid water, 2 to 3 times per week, until her skin improves; pat dry her body to avoid excessive loss of skin oils; and immediately apply an oil-based moisturizer. She should also use the moisturizer 3 or 4 times each day until her skin is back to normal. She can also benefit from indoor environments where the humidity level is higher than normal. In addition, drinking more water will help her feel less dry.2
Dr. Mansukhani is clinical assistant professor at the Ernest Mario School of Pharmacy, Rutgers University, and transitions of care clinical pharmacist at Morristown Medical Center, Morristown, New Jersey. Dr. Bridgeman is clinical associate professor at the Ernest Mario School of Pharmacy, Rutgers University, and internal medicine clinical pharmacist at Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
- Opti-Free Pure Moist. Opti-Free website. www.opti-free.com. Accessed April 6, 2015.
- Benner K. Atopic dermatitis and dry skin. 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; 2015:624.