CASE CONFERENCE #3: Dermatological 1

Date: 08-28-2020

(Due: 08-31-2020 @ 5PM) 

GROUP # 6

TEAM MEMBERS:

Kadesha Fox

Dajana Srbljan

Justin Moody

Sheqira Chambers

Kylee Battelle
DD is a 16-year-old female who stops by the pharmacy with her mother while out
shopping. DD’s mother wants to know which OTC face product(s) would be best
for helping DD treat and prevent blackheads on her forehead, nose, and cheeks.

Upon further questioning, DD’s mother reports that her daughter suffers from
occasional acne flares (starting about a year ago) that seem to worsen with the
onset of menses; however, her blackheads are a constant problem that seem to
make DD anxious and self-conscious about her appearance. DD’s mother has
tried changes in her daughter’s diet and decreasing her sugar and soda intake
but nothing has helped so far.  DD has not yet seen a dermatologist for
evaluation of her condition, but her mother is hoping to improve DD’s condition
with self-care.

-PMH: Asthma, Seasonal allergies

-ALL: Bactrim DS (rash)
-Current Medications: ProAir HFA 1 puff q46hprn SOB/W, Qvar 40mg BID,
Allegra 60mg QD
 PHARMACIST PATIENT CARE PROCESS (PPCP) FORM

Collect -ScholarMac
   Chief complaint: “Blackheads are a constant problem that seems to
make DD anxious and self-conscious about her appearance.”
 
 
  S (Symptoms): The patient’s mother states that her daughter suffers from
  occasional acne flare. However, her blackheads are a constant problem.
 
C (Characteristics): Black heads on her forehead, nose, and checks. Gets
the occasional acne flares that worsen with menses.

H (History): DD’s mother has tried changes in her daughter’s diet and
decreasing her sugar and soda intake.

O (Onset): a year ago 

L (Location): forehead, nose, and cheeks

A (Aggravating Factors): onset of menses 

R (Remitting Factors): Changes in diet and decreasing sugar and soda

intake 

M (Medications): ProAir HFA 1 puff q46h prn SOB/W, Qvar 40mg BID,
Allegra 60mg QD

A (Allergies): Bactrim DS (rash), pollen

C (Conditions): Asthma and Allergies 

Assess -Establish if this patient is an appropriate self-care candidate.  

  -Provide a rationale for your decision.
 
 
 The patient is not eligible for self-care because she takes Qvar, an
  inhaled corticosteroid, which is an exclusion for OTC treatment. Qvar
  may be causing or exacerbating her acne, therefore she needs to see a
  physician to determine which treatment would be most effective and if
  the patient would benefit from OTC therapy. 
Plan -If this patient is a self-care candidate, suggest appropriate strategies to
  include supportive measures with your recommendations. (List available
options)
 
 
   Recommend the patient to see a physician. Exclusion for treatment due
  to Qvar inhaler. 
   Recommend non-pharmacological treatment : continue to maintain a
  healthy diet and stay hydrated, manage stress, wash face with mild
cleanser, such as Cerave twice daily in the morning and in the evening.
Avoid touching the face as much as possible throughout the day; as to
avoid increasing the risk of introducing foreign oils to the skin that can
clog pores and exacerbate symptoms.
 If a physician indicates that the patient would benefit from OTC
therapy, then there are several products available that may reduce her
symptoms associated with her acne. Our recommendation would be
Zapzyt gel (Benzoyl Peroxide). 

Implement -List your specific recommendation. If recommending self-care strategies to

  this patient, list the information you will TALK with the patient regarding the
recommended strategies and goals of therapy.
 
   Refer the patient to a doctor to discuss the possibility of her acne
  resulting as a side effect of QVAR. Allow her doctor to determine if
  pharmacological changes may be needed. Have her doctor give the
  approval to possibly implement OTC acne treatment with concurrent
use of QVAR. 
o With approval to use OTC treatment: Inform patient to use
Zapzyt gel
o Product should be applied to clean skin (freshly washed). Apply
the gel to the area where acne is present up to three times daily.
If patient is using any facial moisturizers for acne, inform her to
apply the Zapzyt product prior to applying makeup/moisturizer
o Patient should continue to use product until symptoms resolve
o Patient should continue to use this product as a preventative
treatment after acne clears up
o Irritation may occur, as well as itching, burning, or redness. If
this becomes severe cut back on the amount of product to
gauge if side effects are based upon the amount of product
used. If irritation and its associated side effects do not disappear
stop the usage of this product

 Educate the patient to continue to monitor diet, hydration, and stress. 

 Educate the patient to continue to use Cerave in the meantime. 

Follow-up:  -When can the patient expect relief from symptoms?  

Monitor and Evaluate  -When should the patient seek his primary care provider? 
   
 The patient can expect relief from symptoms in the timeframe specified
 
by the physician.
   If the patient’s physician recommends Zapzyt gel, then the patient can
expect relief from symptoms within as little as 5 hours, however the
relief varies from patient to patient.
 However, if symptoms worsen, then the patient should contact their
PCP, regarding a possible referral to a dermatologist.