Skin Care in the Community Pharmacy

Community pharmacists play a significant role in helping patients to maintain the health of their skin. From reducing the risk of sun exposure by recommending appropriate sunscreens to counseling patients on the use of OTC acne medications, pharmacists frequently are the frontline health care professional for what is our body’s largest organ. Pharmacists are ideally positioned to counsel patients about the importance of appropriate skin care. It is important for community pharmacists to be aware of skin disorders and cancer risks so they are able to help their patients by providing preventive and early-stage care.

Because many medications can compromise skin health, brown bag sessions are ideal not only for reviewing patient medications, but also the risks of developing preventable conditions. Counseling patients can also help to prepare them for serious or cosmetic adverse effects that include rash, itching, redness, or discoloration.

Skin Cancer Prevention

KH is a 45-year-old woman who is a relatively new customer to your pharmacy. Through a prior counseling session, you learned she is employed as a security guard at the local college and spends most of her day outside patrolling the campus. KH is not very aware of her health and prescription medications. Today, she stops in to the pharmacy to pick up her new prescription for ciprofloxacin. You counsel her on ciprofloxacin and explain the concept behind a brown bag session. You think KH would be a great candidate to participate in a review since you have noticed an increase in her prescription volume and antibiotic use over the past few months. KH is curious and appreciates your attention. She sets up an appointment to meet with you tomorrow.

To prepare for tomorrow’s session, you pull up KH’s pharmacy profile so you will be able to compare it to what is in her “brown bag”:

• Levofloxacin 500 mg once daily for 7 days, discontinued

• Ibuprofen 600 mg twice daily, as needed

• Levothyroxine 25 mcg once daily, every morning

• Esomeprazole 40 mg, once daily

• Vitamin D3 1000 IU twice daily, as directed

• Ciprofloxacin 500 mg twice daily, for 7 days

KH arrives the next day for your appointment with pen and paper ready to create a list. She empties her brown bag and you notice these additional medications:

• OTC aspirin 81 mg once daily

• Calcium carbonate 1000 mg once daily

• Adult multivitamin once daily

• OTC omeprazole 20 mg once daily

• OTC topical retinoid

• Retin-A samples, not labeled and expired

• OTC benzoyl peroxide solution

As you review the medications for accuracy, KH tells you that her selfesteem has been low and she thinks her stress is impacting her health and mood. You ask her to explain further, and KH tells you the winter weather has made her depressed. She places her hands on yours and explains how dry her skin feels. KH explains that the dryness also is making her face feel terrible. As a result, she is feeling self-conscious. She says that none of the products she has been using on her skin work, which is causing her panic and frustration. She complains that if she uses moisturizer or makeup, her skin gets oily, but if she doesn’t, her skin is red, full of pimples, and itchy.

You calm KH down and explain that her regimen could be improved. The combination of harsh weather and use of too many medications may be aggravating her skin. Since KH primarily works outdoors, you counsel her on proper protection from the sun, cold, and wind. You also review sunscreens, as KH is surprised to learn that sunburn can happen in the winter. You stress the importance of hydration and to limit lengthy hot showers, which can dry out skin. KH confesses that she hardly ever drinks water and forgets to hydrate at work. You explain this may be the cause of her increased use of antibiotics for diagnosed urinary tract infections.

KH also has some brief questions about her diet as it relates to her gastrointestinal discomfort and gastroesophageal reflux disease. You counsel her on the importance of follow-up and confirm the medications she is taking for her diagnosis. What other counseling tips and advice could you give KH as it relates to her job, current medication list, skin care, and cancer prevention?