Advising on Acne. Training for the pharmacy team. Dual action against spots and acne

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1 Advising on Acne Training for the pharmacy team Dual action against spots and acne

2 Acne update Many people have memories of looking in the mirror as a teenager and feeling upset to see the appearance of spots. This will no doubt have evoked feelings of embarrassment, anxiousness about what friends would think or, in some cases, even depression. Even if you don t have personal experience of acne, try to empathise with customers who are suffering from it and recognise their need for a quick and effective treatment. Acne is very common it affects approximately 80 per cent of young people between the ages of 11 and 30 years so it is likely that you will encounter customers who are affected by it. Acne usually peaks between the ages of 14 and 17 in girls and 16 and 19 in boys. It usually disappears by the time a person is in their twenties, but in some cases, it can continue into adulthood. Symptoms can vary from person to person, but range from: Comedones whiteheads and blackheads caused when follicles become plugged with sebum and dead cells Papules small red spots Pustules inflamed and pus-filled spots Nodules large lumps under the skin The severity of the spots varies from person to person and ranges from a few blackheads on the face to larger pustules on the face, back and chest. Acne is a condition that customers will often self-diagnose, and the pharmacy will be their first port of call for purchasing treatments. Given this, there is an important role for the whole pharmacy team in helping customers to select the most suitable product and giving them self-help advice on managing the condition. This training booklet provides pharmacists and pharmacy support staff with an update on mild to moderate acne and the different Quinoderm treatments available. Customer scenarios are included to help put your knowledge into practice when recommending effective acne management. Customers with mainly comedones are classed as having mild acne, whereas those with a combination of comedones and some pustules are said to be suffering from moderate acne. Severe acne sufferers will have nodules. Refer anyone who has: A large number of pustules or papules Tried acne treatments but their condition is getting worse Weeping, crusting or bleeding of the area Did you know? Datamonitor reports that medicated skincare will account for 13.3 per cent or 406m of the UK OTC healthcare market in 2014 The same report also says that acne treatments account for 25 per cent of medicated skincare sales Ref: Datamonitor. OTC Healthcare in the UK to 2014 Market Databook. June Causes Acne in teenagers usually occurs at the time of puberty, when there is an increase in the levels of the hormone testosterone in the body (in both men and women). This causes an increase in the production of sebum, which can lead to a series of events within the skin that result in the appearance of spots. These include: 1. Increased production of sebum by the sebaceous glands, giving the skin a greasy appearance. 2. The excess sebum combines with dead cells to form a plug, blocking the hair follicle and causing whiteheads and blackheads. The facts Acne (also known as acne vulgaris) is a chronic skin condition involving inflammation of the hair follicles and sebaceous glands. It usually occurs on the face but can also affect the upper back and chest, where the sebaceous glands are most prevalent. 3. This may be followed by a bacteria called Propionibacterium acnes growing on the skin (as the ph of the skin changes during puberty). The bacteria thrive on the trapped sebum in the blocked follicles, resulting in infl ammation (papules) and then infection, which appears as redness and pus (pustules). Acne can also be linked to changing levels of hormones in women (e.g. prior to menstruation or during pregnancy).

3 Myths Myth: I have acne because I eat too much chocolate and not enough fruit and vegetables. Fact: There is no evidence that a bad diet causes acne. However, everyone should be encouraged to eat a healthy, balanced diet for their general wellbeing. Myth: My skin is very clean and I wash my face several times a day. Why do I have spots? I thought they only affected dirty skin? Fact: Acne is not caused by poor hygiene and is not improved by washing the face frequently. In fact, over-washing the skin may aggravate the spots. Washing the skin twice daily is suffi cient. Myth: Squeezing blackheads or spots will get rid of them. Fact: Squeezing spots should be avoided as this can make the condition worse by spreading the infection and may even lead to permanent scarring. How acne affects sufferers Even mild acne can have a major effect on a sufferer s life especially as most sufferers are teenagers who may already be feeling a bit self-conscious. Acne can make people feel embarrassed and self-conscious about their appearance. In the worst cases, they may actually avoid going out and socialising or feel that no-one will want to have a relationship with them. People with acne may also be anxious that it could result in permanent scarring of their skin. For all of these reasons, when you are talking to customers about their acne, you should be sensitive and supportive and try to alleviate their worries by reassuring them that there are effective products available that can help. If they look embarrassed, take them to a quiet area of the shop so that you can have a full discussion with them about the treatment options. Managing expectations Because acne affects a person s appearance, they will often be looking for something that will l give them instant results. It is important that you manage their expectations and explain that although treatments are usually very effective, they may take some time to see the results. Be sure to emphasise that it is important that they do not stop the treatment after a few days or even a few weeks because they have not seen any improvement. Explain that in most cases, they will see a visible improvement within two months and encourage them to keep using the treatment as directed. Self-help tips When talking to customers about their acne, you can add value to your service by passing on some self-help tips that they could try, such as: Use gentle cleansers morning and night to keep the skin clean Use water-based moisturising creams rather than oil-based or greasy ointments to combat the drying effects of some acne treatments Use oil-free and non-comedogenic make-up Wash hair regularly, especially if it falls over the face It s also a good idea to use the instructions on the packaging to explain to the customer how they should use the product, emphasising the important points and encouraging them to use it regularly. Treatment options Most cases of acne are mild and can be managed with OTC products. However, in severe cases, sufferers may need to see their GP or a dermatologist for prescription treatments. The treatments available OTC in the pharmacy include those containing: Benzoyl peroxide this has the following actions in the treatment of acne: Keratinolytic breaks down the surface of the skin, causing it to shed and unblocking the follicles Antibacterial action kills the P. acnes bacteria which cause the infection of the follicles When recommending products containing benzoyl peroxide, advise customers that they may: Cause the skin to become dry or red, with some burning or stinging. Assure them that these effects are usually mild and will disappear after the treatment has stopped or after a few weeks when the skin has become accustomed to the treatment (see PIL). Always recommend that customers start with the lowest strength product to help minimise this effect Make the skin more sensitive to UV light, so they should take care in the sun and, if the area is going to be exposed to the sun, they should use a sunscreen Bleach clothes, towels and bed linen. Hands should always be washed after applying the product and white towels and bed linen used where possible Potassium hydroxyquinoline sulphate this has antibacterial qualities and is added to reinforce the properties of the benzoyl peroxide, providing a dual action strategy against acne. Nicotinamide is an anti-infl ammatory that works by reducing the redness and infl ammation of spots. Salicyclic acid and salicylates work by promoting shedding of the skin which, then helps to remove the plugs of dead cells and sebum from the blocked follicles. Antiseptics (e.g. cetrimide and chlorhexidine) help to reduce the effects of the bacteria by inhibiting their growth.

4 Fact File Quinoderm 5% Cream Quinoderm Antibacterial Facewash A cleansing face wash with an antibacterial action that can be used as a soap substitute. Contains: Chlorhexidine digluconate 0.15% w/w and myrtrimonium bromide1.5% w/w. A dual action product for the treatment of acne available over the counter without a prescription. A milder version for those with fewer spots or more sensitive skin. Directions for use: Morning and night: wet hands and face and apply Quinoderm Facewash generously. Massage gently onto the face, paying special attention to the nose, cheeks, chin and forehead. Rinse thoroughly. Contains two active ingredients: 5% benzoyl peroxide antibacterial and keratolytic Potassium hydroxyquinoline sulphate which has antibacterial qualities and reinforces the properties of the benzoyl peroxide Directions for use: Apply thinly two or three times daily by massaging over the affected area. Available in: 50g tube. Quinoderm 10% Cream A dual action product for the treatment of acne available over the counter without a prescription. Contains two active ingredients: 10% benzoyl peroxide antibacterial and keratolytic Potassium hydroxyquinoline sulphate which has antibacterial qualities and reinforces the properties of the benzoyl peroxide Directions for use: Apply thinly two or three times daily by massaging over the affected area. Available in: 50g and 25g tubes. For more than 55 years, Quinoderm, a heritage brand, has given generations of teenagers and parents relief from acne. For further product information, visit the healthcare professional section of the Quinoderm website at SmPC can be found on the back cover.

5 Spot on conversations Conversation 1: Customer: A mother asks for advice for her son. He is only 13, but has started getting spots on his face and back and he is very upset. Reassure the customer that spots are very common during puberty and that her son will most probably grow out of them. Explain that spots are caused by an increase in the male hormone testosterone, which can make the skin produce more sebum (an oily substance). This can block hair follicles and pores in the skin, leading to spots. Explain that there are products available from the pharmacy that will help. Customer: Can you recommend a product that will act quickly please? Explain that, unfortunately, there is no quick treatment for acne, but there are effective treatments that will help clear the spots over time and prevent more from appearing. Suggest that he tries the only product with a dual action that is available OTC Quinoderm Cream. Explain that this works by stopping the dead cells from blocking the follicles as well as by reducing the bacteria that can cause the follicles to become infected. Recommend that her son starts using the 5% cream (the lower strength) first, applying it twice a day to his spots and the surrounding area. Manage the customer s expectations by explaining that, as with most acne treatments, it will take about two months before he sees any noticeable improvement and it is important he uses it every day. Warn the customer that this product contains benzoyl peroxide, which is an effective treatment for acne, but they need to be careful as it can bleach clothes, towels and bed linen. Suggest that the customer uses white linens to prevent discoloration. Conversation 2: Customer: A young teenage girl, looking a bit embarrassed and nervous, is browsing the skincare section in the pharmacy and picks up a product for spots. Approach the girl and ask: Are you looking for something in particular? Explain that there are other creams for acne which are only available at the pharmacy counter, and offer to show them to her. Customer: I want some strong cream to help clear my spots I have tried Quinoderm 5% Cream already. Ask how long she has been using this cream. Customer: I have been using the cream for the last two weeks every night. Mention that it can take up to two months before any improvement is seen. It is important that the customer carries on using the cream regularly to help reduce the number of spots she has and to prevent new ones from forming. Suggest that if the girl has not had any skin irritation with the Quinoderm 5% Cream, she could move on to the stronger Quinoderm 10% Cream, which also needs to be applied regularly twice a day. Customer: My mum says I ve got spots because I eat too much chocolate. Is that true? Explain that this is a myth and that a poor diet does not generally cause acne. In fact, most teenagers get spots at some time because of the hormonal changes that occur at puberty. This can cause more sebum (an oily substance in the skin) to combine with dead skin cells and block the pores, which then become infected. Quinoderm Facewash helps to unblock the pores and reduce bacteria. Mention that for general wellbeing, however, it is important to have a healthy and balanced diet. Customer: Is it okay to wear makeup to help cover my spots? Customer: I have told him that he was probably getting spots because he wasn t washing his face properly and now he is washing his face several times a day. Explain that this could make his spots worse, so recommend that he only washes his face in the morning and at night-time with an antiseptic face cleanser that is suitable for acne-prone skin, such as Quinoderm Facewash, and then leaves 20 minutes before applying the cream. Explain that some make-up products may block the pores and make spots worse, but there are cosmetics and foundations that are referred to as non-comedogenic that she should look out for. This type of make-up is best for skin that is prone to spots. However, it is important that she removes any make-up at night and cleanses her skin twice a day with a gentle cleanser suitable for acne-prone skin, such as Quinoderm Facewash, followed by an oil-free moisturiser.

6 Test your knowledge Pharmacist CPD support notes reflect In Practice Looking at the different products stocked in your pharmacy, complete the following questions and then discuss your answers with the pharmacist. 1. List products containing: a. Benzoyl peroxide b. Nicotinamide c. Cetrimide d. Salicylic acid 2. For each of the following, give an example of a product you stock: a. Gel b. Cream c. Lotion d. Facewash 3. Give an example of an acne product that works by: a. Encouraging skin shedding b. Reducing the level of P. acnes c. Unblocking follicles d. Reducing inflammation Self-test questions Test your knowledge by completing these multiplechoice questions. Tick the correct answer and then discuss with the pharmacist. 1. Which of the following hormones can result in increased levels of sebum? a. Adrenaline b. Testosterone c. Oestrogen 2. Acne involves which of the following? a. Sebaceous glands b. Hair follicles c. Both of above 3. Acne is common in people aged: a. 36 years and over b. 11 to 20 years c. 21 to 35 years 4. Which of the following is true? Benzoyl peroxide works by: a. Keeping the skin clean b. Reducing inflammation c. Unblocking follicles 5. Quinoderm is available as: a. Cream b. Facewash c. Both of the above 6. Quinoderm Cream contains benzoyl peroxide and what other active ingredient? a. Potassium hydroxyquinoline sulphate b. Salicyclic acid c. Cetrimide Training for all members of the pharmacy team is an important aspect of your role. The aim of this training is to ensure that customers receive a first-class service when they request advice about acne and the treatments available. This training guide can be used to provide pharmacists with: 1. A training resource for support staff to refresh their knowledge of acne and acne treatments. Encourage staff to read the guide, look at the acne products you stock and complete the activities and questions at the end. You can then review their answers, give positive feedback and help fill any gaps in their understanding. (The answers to the self-test questions are at the foot of the opposite page.) 2. A CPD opportunity that can contribute to one of the nine mandatory entries required by the General Pharmaceutical Council. Remember that training of support staff can be used as CPD. Here are some prompts to help with your CPD entry: 1. Review the different types of acne treatments stocked: is there a range of products that contains different active ingredients and different formats? 2. Discuss ways in which your staff can identify customers who require advice on acne and treatments. Think about signposting acne treatments and advice available from the pharmacy counter. 3. What are the possible complications of acne vulgaris and prescribed treatments? 4. Further information on acne can be obtained from: The healthcare professional section of the Quinoderm website: evaluate the cpd cycle act plan Answers: 1. b, 2. c, 3. b, 4. c, 5. c, 6. a

7 Name and active ingredients: Quinoderm 10% / 0.5% w/w Cream (benzoyl peroxide 10% w/w and potassium hydroxyquinoline sulphate 0.5% w/w), Quinoderm 5% / 0.5% w/w Cream (benzoyl peroxide 5% w/w and potassium hydroxyquinoline sulphate 0.5% w/w). Indications: Acne vulgaris, acneform eruptions, folliculitis. Dosage and administration: For topical use only. Adults, children and the elderly: Gently massage over all the affected area two or three times daily. Contraindications: Acne rosacea. Patients with known sensitivity to either of the active ingredients. Precautions: Contact with mouth and eyes should be avoided. Care should be taken to avoid contact with dyed fabrics as this product may adversely affect dye fastness. In a few isolated cases, overreaction to Quinoderm Cream may occur. To minimise this possibility, select a small area of skin behind the ear, apply the cream and leave for 12 hours. If severe irritation or pronounced redness occurs, do not proceed with treatment. Benzoyl Peroxide is an oxidising agent. Hence, Quinoderm Cream should not be used at the same time as other topical agents which would react with an oxidising agent. Undesirable effects: Local irritation or inflammation may result; in such cases use should be interrupted or frequency reduced. Itch or rash may occur in which instance treatment should cease and a Physician or Pharmacist consulted. Trade price: 10% 25g , 10% 50g , 5% 50g Legal Category: P. Marketing Authorisation Number: 5% - PL 16853/0138, 10% - PL 16853/0139. Marketing Authorisation Holder: Alliance Pharmaceuticals Limited, Avonbridge House, Bath Road, Chippenham, Wiltshire, SN15 2BB, UK. Date of revision: 09 May Adverse events should be reported. Reporting forms and information can be found at Adverse events should also be reported to Alliance Pharmaceuticals. Alliance Pharmaceuticals Ltd Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB United Kingdom Tel: +44 (0) Fax: +44 (0) info@alliancepharma.co.uk Original content developed by 2013 CIG Healthcare Partnership AL/1456/03.13/0.001 Date of preparation: May 2013

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