Boots ROI Healthcare Assistant Programme Module 2

Healthcare Advisor
Programme
Building knowledge, skills
and behaviours
Stage 2: Module 2
Ireland
Contents
Module 1:
Section 1
Gastrointestinal
health
(click to go to this section)
Section 2
Skin conditions
Section 3
Footcare
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Back to Contents
Expert Customer Care

Healthcare Advisors are usually the first point of
contact for customers asking for advice about
health and medicines in Boots and customers
often have high expectations of you and your
colleagues.
Our aim is to be the best pharmacy-led health and

beauty retailer in the world and you can help
achieve this, by using your customer care skills
and expert healthcare knowledge to give cus-
tomers the best experience possible when they
come to Boots.
Back to Contents Healthcare Advisor Programme
Stage 2 Module 2: Introduction

In this module, we have grouped together different health topics for you to work through to increase your
product knowledge, enabling you to respond to customers’ symptoms, recommend products and give advice.
We have included this introduction at the beginning of each module and you may find it helpful to refer back
to the Stage 1 Foundation Module at points while you work through this module.
Person-centred care
In the Stage 1: Foundation Module you worked through a number of sections including;
Person-centred care, the Boots Healthcare Way and Requirements of the law when selling medicines. You
will need to apply what you have learned from these sections throughout the rest of the programme, as you
learn more about different health topics and increase your product knowledge.
Healthcare Advisors are usually the first point of contact for customers asking for advice about health and
medicines in Boots and customers often have high expectations of you and your colleagues.
Our aim is to be the best health and beauty retailer in the world and you can help achieve this, by using your
customer care skills and expert healthcare knowledge to give customers the best experience possible when
they come to Boots.
Module structure and content

Each module is divided up into four, five or six smaller sections each containing a different health topic. Each
of these smaller sections is divided into five main areas, taking you on a journey from the causes of the
condition, the symptoms your customer is likely to ask about, the treatments available and the solutions
(product regimes, advice and so on) you can recommend to customers. You will also look at wellbeing advice
and recommendations for customers to help prevent conditions from returning. You will find learning
outcomes are at the start of each section and these tell you what you should be able to achieve when you
have finished that section. Throughout the module you will be sign posted to activities which can be found in
your workbook. This workbook will allow you to embed your learning and will allow you to make notes along
the way. Finally, you will have the opportunity, in your workbook, to undertake some self-check activities, to
check your understanding and to complete a section review to help prepare for meetings with your tutor and
the eTest at the end of this module.
Healthcare Academy 4
Causes and symptoms

Understanding the causes and symptoms of common minor illnesses and conditions you are likely to see in
the pharmacy helps you identify when to recommend products to customers and when to refer customers
to the pharmacist.
When to refer
In the modules, we’ve highlighted ‘when to refer’ information with the warning bell symbol to alert you
to customers who will need to speak with the pharmacist.
When to recommend
In the modules, we’ve highlighted ‘when to recommend’ information with the tick symbol, so you
7
know when it is appropriate to recommend products.
Additional question
Where you may need more information from your customer regarding their symptoms we have used the
‘additional questions’ symbol.
Additional questions, often about symptoms, can help determine more accurately what condition the
customer has, and the best treatment regime.
Look out for the symbol to highlight ‘additional questions’.
“
Treatment
For each condition, it’s helpful to look first at the active ingredients commonly used to relieve symptoms.
Sometimes there are several different types of treatment for a condition and sometimes only one or two.
You will find the information divided up by treatment type and by active ingredients (drugs). There’s usually
an activity to help you find out about products containing these active ingredients. Also, look out for the
following symbol indicating information that is being highlighted as a special caution. You’ll become familiar
with this symbol as you work through the sections:
Special cautions about treatments and the groups of people that may be affected.
!
Is there an alternative approach?

We’ve included a section highlighting what alternatives there may be for customers who specifically ask for
something other than mainstream medicines, or where mainstream medicines are not suitable. You will
need to refer to customer leaflets, display materials and other sources of information to help find alternative
and complementary products , homeopathic and herbal remedies, aromatherapy and non-drug products. It is
not necessary to memorise the products in this section, it is intended to be used as a guide.
Remember
Some alternative products may not be suitable for all customers, so take care over the advice you give.
Personalised and tailored solutions

Having looked at the different treatments and products available, you will spend time on finding the best
personalised and tailored solutions for your customer’s needs. This may be recommending one product
used on its own, or two or more products used as a regime (for example, a day-time and night-time product
for a particular condition, or a cream and a powder that work together). Being able to explain the benefits of
a particular product helps your customer understand what it will do for them, so it’s important to be able to
describe how different products work and link this to what your customer needs. We’ve included advice on
how to get the best out of products. To reinforce the importance of The Boots Healthcare Way to establish
your customer’s needs and help you sell medicines safely, you’ll see the following reminders.
••• C Counsel
Avoid
CARE
x A
R Read
! E Escalate
W Who is the medicine for?

WWHAM
+ W What are the symptoms?
H How long have they had the symptoms?
A Action taken already?
+ M Medicines they are taking?
Information
For some products you will need to give customers specific information to ensure they can use the
medicine appropriately, and we’ve highlighted this with the following symbol. i
Prevention and advice

Often customers will ask for advice about preventing a condition from recurring. There may be a number of
factors involved like: diet, vitamins and supplements, lifestyle issues, smoking, hygiene and using products
preventatively. We’ve captured these points, which you may find useful with your customers when giving
advice or recommending products and services to prevent illness and promote wellbeing.
Self-check and section review

You will find a selection of multiple choice and short-answer questions, along with case studies to work
through in the accompanying workbook. These questions help you consolidate your learning, and we’ve
included the answers or highlighted where you can find the answer in each section.
The corresponding section review, in the workbook, asks you to think about the following four points:
• What I learned
• How I can apply what I learned
• Talking points to discuss with the pharmacist
• What I will do differently
Reflecting on your learning, as you progress through the programme, helps you reinforce what you have
learned and helps you identify the things you want to talk to your tutor about at your regular meetings. For
instance, you may want to note down information about a brand new product, or about a particular customer
you served that prompted you to go and find out about products and services in your store.
Remember
Keep any notes about customers anonymous, so they cannot be identified.
Sources of help and information

Within the pharmacy and healthcare area of your store, you will find lots of sources of help and information,
which you can use during your training and beyond. We suggest you locate the following sources of
information, and use them as needed:
• Over The Counter (OTC) medicines references
• OTC product information leaflets
• Boots Guide to vitamins, minerals and supplements
• Online resources such as Boots Live, Boots.ie
• Healthcare Academy, Boots Learning
• MIMS
If you are not sure about where to find any of these, ask a more experienced colleague.
Activities
Some activities involve looking at products stocked in your pharmacy. You will need to plan times to do
these activities so that they fit in with the day to day running of the business. Using reference sources
available in the pharmacy will help for a number of activities and you may find it helpful to divide tasks up
into smaller slots, so you can make the most of quieter times during your day.
We’ve included an average guide time for activities to help you and your tutor plan ahead. Read the
instructions and gather together any materials you need before you start each activity, to make the most of
your training time in store.
Preparing for assessment

Most of what is assessed through the MCQ eTests and in the performance standards is what you will be
doing every day in your role in healthcare. Using your time plan and trainee progress record, agree with your
tutor when you will be ready to sit the assessment for each stage.
Make sure you have worked through all the sections in each module, completed the activities and self-check
questions and reviewed each section using the section review. Refresh your knowledge of MCQ styles that
you can expect in the eTest by referring to the Trainee Guide, as needed. Then complete the Module sign-off
review at the end of the module workbook with your tutor before you sit the eTest assessment.
Hints and tips for success

We’ve put together some reminders, hints and tips for getting the most out of the modules in this
programme:
• Plan and organise time to do the activities in each section
• Practise what you will say to customers, when giving advice or dealing with sensitive issues, with more
experienced colleagues
• Keep your workbook or a notebook handy in case you want to jot down notes during the day
• As you become more familiar with products, pick up products and look at the ingredients and pack
information to check you can describe to customers the benefits of that product
• When you come across a product you haven’t seen before, during a quiet time, read up on the pack
information or look it up in an OTC reference source so you know about it for next time
• Refer back to your time plan and trainee progress record and your trainee & tutor learning agreement from
time to time to check you are on track
• Use the Boots Healthcare Way Observation and Feedback Tool to understand how you are progressing
with your consultation skills on the healthcare counter.
Ask your colleagues for their hints and tips too.
Back to Contents
Gastrointestinal health
Module 2 Section 1:
Back to Contents
Most people will suffer
“ from some form of

gastrointestinal
problem at some point.
In most cases this will be
a simple problem that is
easily resolved using
OTC medicines and
“
where relevant advice
and preventative
measures.
Module 2 Section 1: Gastrointestinal

health
Learning outcomes
By the end of this section you will be able to:
• List the main causes of gastrointestinal problems
• Recommend suitable medicines to treat these conditions
• Identify when to refer customers with a gastrointestinal problem to the pharmacist
• Recommend appropriate treatments and lifestyle advice to customers with gastrointestinal problems
• Describe personalised and tailored solutions for customers including advice on prevention and
wellbeing
We will cover the following conditions:

• Indigestion and heartburn
• Constipation
• Diarrhoea
• Irritable bowel syndrome
• Nausea
• Haemorrhoids
Introduction
Most people will suffer from some form of gastrointestinal problem at some point. In most cases this will be
a simple problem that is easily resolved using OTC medicines and where relevant advice and preventative
measures.
Section 1: Gastrointestinal health Healthcare Academy 11

Indigestion and heartburn

These two conditions are caused by pain and discomfort in the upper gastrointestinal tract, usually
associated with food. Both have similar symptoms, and your customers may well use one term when they
mean the other. We will look at them separately, so you understand what the differences are between them,
and how you would treat them.
What is indigestion?
Indigestion, or dyspepsia as it is also known, occurs when food or drink is not digested properly. It is a
common condition, and most people will suffer from it at some point. It can be quite mild, only occurring
when a rich meal has been eaten, or much more painful and frequent, which may indicate a more serious
condition.
Causes
When we eat, food passes from the mouth to the stomach, where it mixes with acid and digestive enzymes
produced by the stomach. These enzymes and acid break down the food into liquid. Sometimes there is too
much acid produced, and this causes irritation to the stomach. The burning or pain that is felt when this
happens is known as indigestion. There are many ‘triggers’ that can result in this excess acid, and these
include:
• Eating a large, spicy or fatty meal
• Drinking too much alcohol, tea or coffee
• Smoking
• Stress
• Pregnancy
• Duodenal and stomach ulcers
• Some medicines can cause indigestion
as a side-effect
• Being overweight Mouth
Symptoms
Oesophagus
The main symptoms of indigestion include:
• Discomfort
• Bloated feeling
• Pain in the chest
• Heartburn (see later) Liver Stomach
• Loss of appetite Gall bladder

• Nausea and vomiting
Pancreas
Small intestine
Descending colon
Ascending colon
Appendix
Rectum
Anus
Alimentary canal

When to refer
The following customers / symptoms should be referred to the pharmacist:
• Symptoms that are not related to food or drink
• Indigestion occurring for the first time in middle age or recently changed symptoms
• Symptoms occurring after exercise
• Pain and/or discomfort across the chest and possibly down the left arm
• Pain that wakes the person in the night
• Breathlessness
• Blue lips
• Paleness
• Weight loss
• Jaundice
• Difficulty in swallowing
• Fever
• Symptoms that have persisted despite trying something
• Blood in the stools
• Any customer who is pregnant or breastfeeding
• Anyone taking any other medication
• Has had a previous gastric ulcer or gastrointestinal surgery
When to recommend?
Adults
7
W
+ W Indigestion symptoms mentioned earlier
Couple of days, with recurring intermittent symptoms

WWHAM
H
A Nothing tried
+ M Not taking any medication
Treatment
There are a variety of options available to your customers to treat their indigestion. We shall now look at
each of them in turn.
Antacids
Antacids help by neutralising the excess acid in the stomach. It is common to find a combination of antacids
in preparations. The main antacids are:
• Sodium bicarbonate
• Calcium carbonate
• Aluminium hydroxide
• Magnesium carbonate

Whilst antacids are generally considered to be safe medicines, there are some cautions
associated with their use. !
• Magnesium salts can cause diarrhoea

• Aluminium salts can cause constipation
• People on a salt-restricted diet should avoid products high in sodium
• Antacids should not be taken at the same time as iron tablets, certain antibiotics and medicines that are
enteric coated (prevents medicine being broken down in stomach acid), as they may affect absorption
Many antacid preparations available are combination products of two, three or sometimes four of these
ingredients. The reason for this is because some have a quicker onset of action (e.g. sodium, calcium) and
some a longer duration of action (e.g. magnesium, calcium and aluminium). Also combinations can be useful
to help reduce side effects such as magnesium and aluminium, when combined the customer is less likely
to experience diarrhoea or constipation as a side effect.
Which type of preparation would you like, liquid or tablets?

Liquids have a quicker onset of action, but are heavier to carry and less convenient than tablets. However,
some people find that liquids work better.
Alginates
Alginates work by forming a raft of foam on top of the stomach contents. When the stomach contents are
forced back into the oesophagus, this raft travels upwards first, and therefore protects the oesophagus from
being irritated by stomach acid. Alginates are best taken after meals and at bedtime.
Products containing alginates usually also contain either sodium or potassium so any patient
with high blood pressure or on medication should be referred to the pharmacist. !
Simeticone
This works by helping disperse wind and reduce flatulence. This is used in combination with antacids to
reduce build-up of trapped wind.
H2 antagonists
H2 antagonists work by reducing the amount of acid produced by the stomach. Examples of these include:
• Famotidine
• Ranitidine
H2 antagonists should only be used for up to two weeks, and if the symptoms do not improve
or they get worse, then the customer must see their doctor. They are not suitable for anyone !
under 16 years.

Remember when selling these products to use CARE.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate
Complete the activity in your workbook to find out more about these products used to treat indigestion.
Activity 2.1.1 (15 mins)

Check out customer leaflets, display material and to help find alternative products for your customer.
What is heartburn?
Heartburn is the common name for a condition called gastro-oesophageal reflux. Despite its name, it has
nothing to do with the heart.
Causes
Heartburn is caused by acid from the stomach escaping and moving back up into the oesophagus. When
the acid comes into contact with the delicate lining of the oesophagus it causes pain irritation and
discomfort. Possible causes of heartburn include:
• Being overweight, as it puts pressure on the stomach
• Pregnancy
• Bending or lifting
• Wearing tight clothes
• Fatty foods and alcohol
• Eating large meals late at night
• Smoking

Symptoms
The main symptoms of heartburn include:
• Painful or tightening sensation in the throat
• Taste of acid or regurgitated food in the back of the throat
• Burning sensation in the chest
The symptoms can be made worse by bending or lying down.
When to refer
• Symptoms that are not related to food or drink
• Symptoms occurring for the first time in middle age, or change in symptoms
• Symptoms occurring after exercise
• Pain and/or discomfort across the chest and possibly down the left arm
• Pain that wakes the person in the night
• Breathlessness
• Blue lips
• Paleness
• Weight loss
• Jaundice
• Difficulty in swallowing
• Fever
• Symptoms that have persisted despite trying something
• Blood in the stools
• Has had a previous gastric ulcer or gastrointestinal surgery
When to recommend?
Adults
7
W
+ W Indigestion symptoms mentioned earlier

WWHAM
H
A Nothing tried

Treatment
As with indigestion, antacids may be used to relieve pain. Particularly effective are those containing alginates
as these protect the lining of the oesophagus. H2 antagonists will also provide relief of heartburn, but should
only be used short-term.
Another type of drug that will help in the relief of heartburn or acid regurgitation symptoms is a proton pump
inhibitor.
Proton pump inhibitors

These work by blocking the ‘pump’ that produces stomach acid, reducing the amount of stomach acid. Unlike
antacids these products are not designed to give immediate relief and the customer may only start to
experience relief of their symptoms after approximately one day of starting treatment with a proton pump
inhibitor. It might be necessary for the customer to take it for seven days to achieve complete heartburn control.
Some of the proton pump inhibitors available OTC include pantoprazole, esomeprazole and omeprazole.
Information
For sales involving proton pump inhibitors you need to give your customer the following information:
• It might be necessary to take the tablets for 2-3 consecutive days to achieve improvement of
symptoms. Once complete relief of symptoms has occurred, they should stop taking the medicine
i
• Tablets should not be chewed or crushed, and should be swallowed whole with liquid before a meal
Pantoprazole should not be taken for longer than 4 weeks. Esomeprazole and omeprazole should
not be taken for longer than 2 weeks. If no symptom relief is obtained within 2 weeks of !
continuous treatment, the patient should be instructed to consult a doctor. They are not suitable
for anyone below 18 years of age.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate
The following activity will help you think about selling these products using The Boots Healthcare Way.

When recommending products, think about the following points to cover.
Find out what your customer really wants/what is What symptoms are troubling them most? Do they
most important to them want to feel better to help them do something in
particular?
Confirm that you understand what they want e.g. “So what you want is something that’s going to
work really quickly?”
This shows you are listening and demonstrates
empathy with your customer
Ask about other information you need to help you e.g. “What have you tried so far?” “What other
make a recommendation medicines are you taking?
Make a recommendation, linking the reasons for e.g. “What I recommend is... because...”
your recommendation to what the customer Think about how you will relay information to the
wants pharmacist, if you need to refer the customer
Check for satisfaction of your recommendation e.g. “How does that sound?”
By asking your customer if the product or advice is ok
for them they can feel more informed and confident
about their healthcare needs
Offer any other product you think may be of e.g. “Did you know..........?”
benefit including preventative measures and/or Always provide your customer with a personalised and
advice tips tailored solution to their healthcare needs.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate
Advice
Here is some advice and some counselling points for those who are suffering from indigestion or heartburn.
You might find some or all of them useful to use with your customer when you are finding the solution that
best meets their needs:
• Antacids should be taken only when symptoms are present
• Liquid antacids are faster acting than tablets
• Tablets are more convenient to carry around
• Do not lie down for at least two hours after eating
• If heartburn symptoms are worse at night, try using an extra pillow to raise head and neck area

Prevention
Some or all of the following points may be useful for you to use with your customer:
• Avoid any food or drink that makes the symptoms worse
• Regular small meals are better than large irregular ones
• Caffeine, smoking and being overweight can aggravate the symptoms
The next activity in your workbook will let you think about the different pieces of information you can give to
customers to provide personalised and tailored advice.
Constipation
For details on constipation in children please refer to the Children’s health section in Module 3.
What is constipation?
Constipation is a reduced frequency of bowel movement compared to what is normal for the individual, and
is associated with difficulty in passing hard stools, sometimes with discomfort or even pain.
Remember
The frequency of bowel movements depends on the individual – ‘normal’ could range from three times
a day to three times a week.
Causes
There may often be no identifiable cause for constipation, but it may be due to one or more of the following:
• Low fluid intake
• Not enough fibre in the diet
• Change of diet, for example when on holiday
• Lack of exercise
• Pregnancy
• Some drugs can cause constipation as a side-effect
• Old age
• Slimming
• Anxiety
Symptoms
The common symptoms of constipation are:
• Difficulty in passing stools
• Pain when passing stools
• Solid hard stools
• Abdominal discomfort
• Bloated feeling

When to refer
• Children suffering from constipation
• Blood or mucus in the stools
• Constipation that has lasted longer than a week
• Weight loss that has occurred along with the constipation
• Severe pain when passing stools
• If something has already been tried and has not worked
• Anyone who is pregnant or breastfeeding
When to recommend?
Adults
7
W
+ W Constipation symptoms mentioned earlier
Couple of days
WWHAM
H
A Nothing tried
All other customers should be referred to the pharmacist.
Treatment
Usually constipation can be relieved by eating foods that are high in fibre, such as fruit and vegetables,
wholemeal bread and pasta, and breakfast cereals enriched with bran. Drinking more fluids will help to
soften the stools. Walking and other regular exercise can help to stimulate the bowel.
If these simple lifestyle measures are unsuccessful, then constipation can be treated by using a laxative.
There are different types of laxatives available, and we shall now look at them in turn.
Bulk-forming laxatives
These work by making the faeces (stools) more bulky, which encourages the intestine to move faster. They
also have a tendency to retain water in the faeces, making them softer and easier to pass. They take 24-48
hours to work, and must be taken with plenty of water. Examples of bulk-forming laxatives include:
• Bran
• Ispaghula

Stimulant laxatives
These irritate the bowel, stimulate nerve endings, and force it to expel the faeces. They act in about eight
hours and are best taken at night. Examples of these include:
• Bisacodyl
• Senna
• Sodium picosulfate
Stimulant laxatives should not be used regularly or for long periods of time.
!
Glycerol (Glycerin) suppositories can be used for rapid (will start to work within 30-60 minutes), short-term
relief. Glycerol acts as a lubricant and has a mild irritant action making it easier to move stools along and
pass them out of the body.
Osmotic laxatives
Osmotic laxatives work by drawing fluid into the bowel and faeces, making them easier to pass. They should
always be taken with plenty of water. They can take up to three days to work, but they are a gentle option. A
common example of an osmotic laxative is lactulose.
The following activities will help you learn more about products available for constipation

Check out customer leaflets, display material and other relevant reference sources to help find alternative
products for your customer, list such products in your workbook in the notes section.

Finding the best regime for customer needs
So far you have looked at the causes and treatments of constipation. It’s now time to focus on
recommending products to meet the customer’s needs.
What to recommend
When you have established that the customer, or person the customer is asking for, has constipation, you
can recommend an appropriate product or combination of products and give some personalised and tailored
advice. Remember using WWHAM will help you establish the customer’s needs and CARE to provide advice
about the treatment.

WWHAM WWHAM
W Who - is the medicine for?
+ W What – are the symptoms?
H How – long have they had the symptoms?
A Action– taken already?
+ M Medicines – they are taking?
Find out what your customer really wants/what is What symptoms are troubling them most? Do they want to feel
most important to them better to help them do something in particular?
e.g. “So what you want is something that’s going to work really
Confirm that you understand what they want quickly?”
This shows you are listening and demonstrates empathy with your
customer
Ask about other information you need to help you e.g. “What have you tried so far?” “What other medicines are you
make a recommendation taking?
your recommendation to what the customer wants Think about how you will relay information to the pharmacist, if you
need to refer the customer
e.g. “How does that sound?”

Check for satisfaction of your recommendation By asking your customer if the product or advice is ok for them they
can feel more informed and confident about their healthcare needs
Offer any other product you think may be of benefit e.g. “Did you know..........?”
including preventative measures and/or advice tips Always provide your customer with a complete solution to their
healthcare needs.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate

Advice
Here is some advice and some counselling points for those who are suffering from constipation. You might
find some or all of them useful to use with your customer when you are finding the solution that best meets
their needs:
• Laxatives should not be used for prolonged periods of time except on the advice of a doctor
• The lowest dose should be started (when taking stimulant laxatives) and gradually increased (as per
product directions) until it produces the desired effect
• Give the medication time to work (particularly important for bulk forming and osmotic laxatives as it can
take between two to three days for an effect to be seen)
• Avoid ‘holding back’ when there is the urge to pass a bowel movement, as this will make the condition
worse
Prevention
The following points may be useful for you to use with your customer:
• Eat plenty of fruit and vegetables
• Eat plenty of wholegrain products
• Drink plenty of fluids
• Increase exercise
The following activity will allow you to use the Boots Healthcare Way to provide care to your customers who
are suffering from constipation.
Diarrhoea
For details on diarrhoea in children please refer to the Children’s health section in Module 3.
What is diarrhoea?
Diarrhoea is an increased frequency of bowel movement compared to what is normal for the individual, and
is associated with stools being more fluid or watery.
Causes
There are many causes of diarrhoea and these include:
• Gastroenteritis, which is a bacterial or viral infection
• Food poisoning
• Changes in diet
• Food intolerance or allergy
• Alcohol
• Side-effect of some drugs
• Poor hygiene

Symptoms
The usual symptoms of diarrhoea include:
• Increased frequency of bowel movements
• Stools that are soft and more fluid than usual
• Bloating
• Flatulence
When to refer
The following customers should be referred to the pharmacist:
• Anyone who also is vomiting or has a fever
• Any blood or mucus in the stools
• Anyone who has recently returned from a holiday abroad
• Diarrhoea that has lasted longer than three days (adults), or recurs frequently
When to recommend?
Adults
7
W
+ W Increased frequency of watery stools
No longer than three days

WWHAM
H
A Nothing tried
Treatment
There are two main types of OTC products that can be used to relieve diarrhoea. Traveller’s diarrhoea
(holiday tummy) is covered in the Travel health section in Module 1.
Oral rehydration solutions

In severe cases of diarrhoea, dehydration and electrolyte imbalance can occur, due to the loss of fluids and
minerals (mainly water and salt), and treatment should aim to correct this imbalance. Oral rehydration
solutions are used to correct this imbalance and should be the first-line treatment of diarrhoea in all ages.
Information
For sales involving oral rehydration solutions, you need to give your customer the following information:
• The solution should be made up using fresh drinking water (freshly boiled and cooled water in infants)
• Once made up, the solution should not be kept for more than an hour at room temperature, or 24 hours
i
if kept in a fridge
• When preparing a solution, measure out the amount of water required exactly following the directions on the
product

Anti-diarrhoeal to reduce bowel motility

The anti-diarrhoeal that reduces bowel motility available OTC is loperamide. It acts by slowing down the
intestines and allowing more water and nutrients to be reabsorbed. This will be of benefit for customers who
find it inconvenient to have to go to the toilet frequently but it should only be recommended together with
appropriate fluid replacement.
As it controls diarrhoea symptoms very quickly it is therefore suitable to recommend for customers who are
looking for a product to take on holiday with them.
Loperamide is also found in a product combined with simeticone, which will help to relieve any stomach
cramps associated with diarrhoea. Quick acting reparations are available, which start to work within one
hour. This can be used in those 12 years and over.
Loperamide is not suitable for children under 12.

!
Alternative treatment to restore normal functioning of bowel
An alternative option to loperamide is a medical device also suitable for the treatment of diarrhoea. This
product contains gelatin tannate which acts mechanically to protect the inflamed bowel wall. As a result of
this it is claimed to reduce the frequency and duration of diarrhoea episodes. It should only be
recommended together with appropriate fluid replacement. This product can be used in infants, children and
adults. A pharmacist or doctor should be consulted before it is used in children under 2 years of age. An
example of this type of product is Tasectan. Locate this product in your pharmacy and discuss with your
pharmacist when this product might be suitable to recommend.
Children under 2 years should consult a doctor or pharmacist prior to using Tasectan.
!
You should have already completed the following activity in the Travel health section in Module 1, go back
and refresh your knowledge about the products you noted down.

So far you have looked at the causes and treatments of diarrhoea. It’s now time to focus on recommending
products to meet the customer’s needs.
What to recommend
When you have established that the customer, or person the customer is asking for, has diarrhoea, you can
recommend an appropriate product or combination of products and give some personalised and tailored

WWHAM WWHAM
customer

healthcare needs.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate

Advice
Here is some advice and some counselling points for those who are suffering from diarrhoea. You might find
some or all of them useful to use with your customer when you are finding the solution that best meets their
needs:
• The most important thing is to prevent dehydration and electrolyte imbalance
• There is no need to fast from food. As soon as the person suffering from diarrhoea feels like eating, they
should eat foods high in carbohydrates such as bread, rice, potatoes or pasta. They should avoid
anything too rich or spicy until the diarrhoea has subsided
• Loperamide or tasectan can be recommended together with fluid replacement in healthy adults, if an
anti-diarrhoeal is needed
• Always wash hands before preparing food
• Maintain an adequate fluid intake
Complete the activity below in your workbook, allowing you to consider all the information you have just
read about diarrhoea.
Irritable bowel syndrome (IBS)

What is IBS?
IBS is a common gastrointestinal disorder, which affects more women than men. It causes a variety of
abdominal symptoms.
Causes
The exact cause of IBS is not known, although it often flares up during times of stress or anxiety. Suggested
causes of IBS include:
• Reaction to gastroenteritis
• Lack of fibre in the diet
• Food intolerance
• A disorder of the smooth muscle in the intestine
• Laxative misuse
Symptoms
The usual symptoms of IBS include:
• Recurring severe abdominal pain, usually quite low down in the abdomen
• Diarrhoea
• Constipation
• Alternating diarrhoea and constipation
• Bloating, which is not related to food
• Hard small pellet-like stools
• Abdominal rumblings, which are much louder than usual
• Flatulence and belching

When to refer
• Anyone who has not had a diagnosis of IBS confirmed by their doctor
• Anyone who has unexplained or sudden weight loss
• Continuous pain that does not ease after a bowel movement
• Symptoms that have persisted despite having tried something
• Anyone who is taking any other medication
When to recommend?
Adults
7
W
+ W Some or all of the IBS symptoms described earlier, confirmed by their doctor

WWHAM
H
A Nothing tried
Treatment
There are two main products available to buy OTC to treat IBS. They should only be recommended if the
customer, or person the customer is asking for, has had IBS diagnosed by their doctor.
Antispasmodics
These products work by relieving intestinal contractions and the associated cramping pains. They act
directly on the smooth muscle wall of the intestine to reduce the spasm and therefore help with the pain.
Active ingredients include:
• Mebeverine
• Peppermint oil
• Hyoscine
Mebeverine is only available OTC in a product in combination with ispaghula (a bulk forming laxative). This
combination will help to relax the spasms of the intestine and also help to restore and maintain regular
bowel habits, both of which are common symptoms of IBS.
Peppermint oil is useful for those who want to try a natural product to treat their symptoms.
Hyoscine butylbromide will relax the smooth muscle wall of the intestine reducing spasms and relieving
pain.

Information
For sales involving hyoscine butylbromide you need to give your customer the following information:
•
•
Do not take continuously for more than 2 weeks
Stop taking and talk to your pharmacist if you get new symptoms or your symptoms get worse
i
• Hyoscine butylbromide is not recommended for use in children under 12 years of age.
If the person is suffering from diarrhoea and/or constipation, then you could recommend an appropriate
product to treat these symptoms. Bulking agents can help in some people as mentioned earlier. These have
been covered earlier on in this section.

So far you have looked at the causes and treatments of IBS. It’s now time to focus on recommending
products to meet the customer’s needs.
What to recommend
When you have established that the customer, or person the customer is asking for, has IBS you can
WWHAM WWHAM

customer

healthcare needs.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate
Complete the activity in your workbook to learn more about the products available for customers suffering
from IBS.
Information
For sales involving IBS products, you need to give your customer the following information:
•
•
The diagnosis of IBS must be confirmed by the doctor before self-treating
If symptoms persist for more than two weeks then see the doctor
i
• If pregnant or breastfeeding then see the pharmacist

Advice
Here is some advice and some counselling points for those who are suffering from IBS. You might find some
or all of them useful to use with your customer when you are finding the solution that best meets their
needs:
• Take steps to reduce stress
• Try not to rush meals
• Take regular exercise
• Use relaxation techniques if appropriate
• Eat a balanced diet with regular meals
• Try to cook fresh meals, rather than buy processed foods
• Drink plenty of fluids
Nausea
What is nausea?
The only nausea that can be treated OTC is nausea that is related to eating. Nausea can be described as a
feeling of sickness characterised by an urge to vomit.
Causes
In this case the nausea has occurred after eating a meal.
Symptoms
The symptoms associated with nausea that can be treated OTC include:
• Belching
• Feeling of fullness
• Stomach discomfort
When to refer
• • Where a cause, other than nausea following a meal, is suspected
• Anyone with symptoms that have persisted or become worse
• Anyone who is vomiting as well as suffering from nausea
• Anyone asking for advice about morning sickness
• Anyone requesting a domperidone containing product or where a domperidone containing product is considered
appropriate
• Anyone under 16 or over 60 years

Treatment
The product available OTC contains domperidone. It helps the stomach to move food through the digestive
system normally. Domperidone is only indicated for the relief of nausea and vomiting in adults and
adolescents 16 years of age and older and weighting over 35kg. While domperidone will also help with
symptoms such as bloating and fullness associated with nausea and vomiting.
From the SOP OTC, you will be familiar with the proctocol for Domperidone. It contains the
protocol to be followed when a customer requests a medicine containing domperidone. Studies
have shown that domperidone may be associated with an increased risk of developing dangerous
heart problems. This risk may be higher in persons aged over 60, persons taking certain
medication and when domperidone is taken at doses greater than 30mg domperidone daily (i.e.
more than one 10mg tablet three times daily).
Therefore, domperidone is only indicated for nausea and vomiting. The recommended dose in adults and
adolescents is 10mg orally up to three times daily with a maximum dose of 30mg per day. It should be
recommended at the lowest effective dose for the shortest possible period, which should not exceed one
week.
Information
For sales involving domperidone, if after consulting with your pharmacist and they have approved the
sale, you need to give your customer the following information as part of the CARE framework:
• Domperidone is only indicated for the relief of symptoms of nausea and vomiting
i
• Take the lowest effective dose and for short term use only
• If taking any medicines from the doctor or dentist speak to the pharmacist
• Not suitable for anyone who is pregnant or breastfeeding
• Not suitable for anyone under 16
• If symptoms get worse or more frequent then see the pharmacist
Complete the following activities to learn more about domperidone.

Haemorrhoids
What are haemorrhoids?
Haemorrhoids are swollen veins (which have become stretched and weakened) around the anus, and they
are also known as piles. They can become inflamed, itchy and sore, and may bleed. They can cause
considerable discomfort and embarrassment to sufferers. There are two types.
Internal haemorrhoids
This is when the swollen veins present in the wall of the anus protrude into the anal canal and become
damaged, causing stools to be streaked with blood. They cause soreness and itching around the opening of
the anus.
External haemorrhoids
This is when the swollen veins are pushed out of the anal opening when the bowel is opened. Often it will
retreat back into the anus after a bowel movement. If the haemorrhoid remains hanging outside the anal
opening it may become inflamed, hard and painful.
Causes
The direct cause of haemorrhoids is usually straining when passing a hard stool due to constipation.
However there are a number of factors that can contribute to the production of haemorrhoids:
• A poor diet may lead to constipation and then haemorrhoids
• Low fluid intake may also cause constipation and then haemorrhoids
• Lack of exercise
• Prolonged sitting or standing may cause pooling of blood in the anal veins leading to haemorrhoids
• Hormonal changes in pregnancy means constipation is a common problem as the intestinal muscles are
more relaxed and both of these factors make the vein walls more likely to stretch
• As a pregnant womb expands this can lead to ballooning of the veins due to pressure on the rectum
• Childbirth can stretch the anus and cause haemorrhoids, in the same way as straining when going to the
toilet
Symptoms
The usual symptoms of haemorrhoids are:
• Itching and soreness of the skin around the anus
• Dull ache in the anal region
• Pain or discomfort when passing a bowel movement
• Stools streaked with bright red blood on the surface
• Bright red blood in the toilet and on toilet paper
• Swelling around the anal region

When to refer
• Anyone who has not had a diagnosis of IBS confirmed by their doctor
• Anyone who has unexplained or sudden weight loss
• Continuous pain that does not ease after a bowel movement
• Symptoms that have persisted despite having tried something
When to recommend?
Adults
7
W
+ W Haemorrhoid symptoms described earlier
Less than two weeks

WWHAM
H
A Nothing tried
Treatment
There are a variety of products available OTC to treat haemorrhoids. They are available as:
• Creams
• Ointments
• Gels
• Suppositories
• Medical Devices
Ointments are useful when the surrounding skin area is dry. Creams and gels are water based and will be
absorbed into the surrounding area easily, Suppositories are effective at treating internal haemorrhoids.
Soothing wipes are available to soothe and cleanse the anal area. These are designed to be used in place of
regular toilet tissue. We shall now look at the different types of treatment available. Many products contain a
combination of ingredients.
Astringents
Astringents help to soothe the area and are believed to form a protective coat over the haemorrhoid. They
are sometimes combined with local anaesthetics, and include:
• Bismuth salts
• Hamamelis (witch hazel)
• Zinc oxide

Antiseptics
These have a soothing and antiseptic action. Examples of these are:
• Balsam Peru
• Cetrimide
Hydrocortisone
Hydrocortisone relieves inflammation, thereby promoting healing and reducing itching and discomfort.
Hydrocortisone should not be used during pregnancy.

!
Information
For sales involving hydrocortisone products for haemorrhoids, you need to give your customer the
following information as part of the CARE framework:
• Should not be used for longer than 7 days
i
• If pregnant or breastfeeding, speak to the pharmacist
Medical Devices
Medical devices which involve cryotherapy, i.e. freezing the haemorrhoid are now available to treat
haemorrhoids e.g. HemorRite. The principle in which this works is that the cold decreases inflammation,
decreasing pain and reducing blood flow to the area. This should result in shrinkage of the inflamed tissue.
Complete the following activity in your workbook to learn more about the products available to treat
haemorrhoids.

So far you have looked at the causes and treatments of haemorrhoids. It’s now time to focus on
What to recommend
When you have established that the customer, or person the customer is asking for, has haemorrhoids you
can recommend an appropriate product or combination of products and give some personalised and tailored
advice.
Remember using WWHAM will help you establish the customer’s needs and CARE to provide advice about
the treatment.

WWHAM WWHAM
customer

healthcare needs.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate

Advice
Here is some advice and some counselling points for those who are suffering from haemorrhoids. You might
find some or all of them useful to use with your customer when you are finding the solution that best meets
their needs:
• Customers should read and follow the instructions on how to use the product carefully
• If the symptoms have not improved after one week, see your doctor
• Frequent washing of the anal area with soap and warm water after having a bowel movement will help
relieve itching and irritation
• Food high in fibre will help to avoid constipation
• Straining on the toilet will make their symptoms worse
• Using moist toilet paper and patting the area dry rather than rubbing it when going to the toilet will help
Self-check questions and review

It’s time to check your understanding of the section you have just been working through and review what
you have learnt. Go to your workbook and make sure you have completed your activities, and following this,
complete the self-check answers and review section.

Back to Contents
Skin conditions
Module 2 Section 2:
Having healthy skin and
“ looking good is part of

the overall concept of
“
good health and all of
us would like to have
perfect skin.
Section 2: Skin conditions
Learning outcomes
• List the main causes of common skin conditions
• Describe the symptoms of common skin conditions
• Identify customers who should be referred to the pharmacist
• Describe solutions for customers, which are personalised and tailored including advice on prevention and
wellbeing
• Recommend suitable products for customers suffering from common skin disorders

• Dry skin
• Contact dermatitis
• Atopic eczema
• Psoriasis
• Urticaria
• Dandruff
• Acne
• Warts
• Ringworm
• Boils
• Excessive perspiration
• Hereditary hair loss
Section 2: Skin conditions Healthcare Academy 40

Introduction
Having healthy skin and looking good is part of the overall concept of good health and all of us would like to
have perfect skin. Any skin conditions affecting appearance can therefore have an effect on the way people
feel. Although tough and protective the skin is also delicate and sensitive, and skin disorders are very
common. In Ireland, it is estimated that 50% of people suffer from some type of skin condition each year.
The skin is the largest organ in the body. It has a complex structure and performs a lot of important functions
including:
• Protecting the underlying tissues
• Preventing bacteria and other microorganisms getting into the body
• Acting as a sensory organ for pressure, touch, temperature and pain
• It also helps to control the body temperature
In this section we are going to look at the common skin disorders you are likely to meet and which may
respond to treatment with over-the-counter medication. Firstly, we will spend some time looking at the
structure of the skin before looking at the conditions that can affect it.
The skin is made up of two main layers:

• The epidermis which is the outer layer
• The dermis which is the inner layer
Under these layers is the subcutaneous layer.
The visible surface layer of the skin is the outer most part of the epidermis and this is made up of a horny
protein material called keratin. This layer is constantly being worn away and replaced by new cells from the
lower layers, which gradually travel upwards to the outer surface. As the cells approach the surface they
become flattened and die, forming a continuous sheath of keratin. In this way, the skin is constantly
repairing and renewing itself.
Pore of sweat gland Hair shaft
Capillaries Sebaceous gland
Cornified layer
Epidermis
Hair follicle
Dermis
Subcutaneous
layer
Sweat gland Blood vessels Nerve fibres Pressure receptor
Diagram of the skin
The epidermis also contains the skin pigment melanin, which protects the skin from the harmful effects of
ultraviolet (UV) light, particularly sunlight. The dermis is the thick lower layer housing the nerves, blood
vessels, sweat and oil glands and hair follicles. Sweat glands and oil glands lubricate the keratin and prevent
it from drying and cracking.

Dry skin
A large number of people suffer from dry skin in different forms and with different degrees of severity. It is
especially common in children under the age of 10 years and older people over the age of 60 years. More
women suffer from dry skin than men.
What is dry skin?

Under normal circumstances the skin is kept soft and supple by the natural lubricating oil called sebum,
which forms an almost watertight barrier to keep moisture in the skin. Anything that reduces the supply of
sebum to the skin can cause dryness leading to chapping, itching and broken, sore skin.
Causes
Dryness of the skin is influenced by many different internal and external factors.
Some of the internal factors are:
• Age – as you get older skin cells are not renewed as quickly and the skin produces less sebum
• Hormone levels
• Certain medical conditions such as eczema and psoriasis
• Some of the external factors are:
• Exposure to sun or wind
• Dry air from air conditioning systems and some central heating systems
• Some skincare products and medication
• Contact with chemicals including washing detergent and soap
• Exposure to UV rays
Symptoms
The symptoms of dry skin can range from mild to severe and may include the following:
• Mild scaling
• Roughness
• A feeling of tightness
• Itching
• Chapping
• Cracking
Dry skin is associated with skin conditions such as eczema, dermatitis and psoriasis, and these conditions
are described in more detail later.

When to refer
• • Anyone who has broken skin
• If the skin appears to have become infected
• Anyone who has a nut allergy, as some of the treatments may contain nut oil
When to recommend?
Anyone over the age of two years
7
W
+ W Dry skin
Less than two weeks

WWHAM
H
A Nothing tried
Treatment
There are many products available for the treatment of dry skin. All aim to replace the water lost from the
skin or restore the balance of oils to the skin’s surface.
Emollients
The most effective treatment for dry skin is an emollient, usually in the form of a cream. Emollients are lipids
that cover the skin surface and help prevent water loss from the surface. They are substances that reduce
the signs and symptoms of dry, scaly skin, making the rough surface soft and smooth.
Emollients have the following actions:
• Replaces lost moisture
• Helps maintain the natural protective barrier
• Allows skin repair to take place
• Prevents further moisture loss
Emollients are used for both prevention and treatment of dry skin conditions. These preparations usually
contain a combination of ingredients such as:
• Soft paraffin
• Liquid paraffin
• Glycerin
• Lanolin (sometimes called wool fat)
Some people have an allergic reaction to products containing lanolin.

If a reaction occurs they should stop using the product. !

Emollients creams can be used all over the body as often as needed but should be applied at least twice a
day to any affected areas, normally morning and night. They are also available as bath formulations to be
added to the bath water and as preparations to be used in the shower or bath as a soap substitute. Some
emollient products by the addition of ingredients called humectants, such as glycerine or urea, actively
hydrate the skin. This is because humectants are water loving and draw water from the dermis into the
epidermis thus hydrating it.
If emollients containing paraffin rub onto clothes or bed linen there is a risk that if it comes into
contact with a flame it may ignite. Therefore customers should be warned to keep this product !
when storing and in use away from flames.
Product selection
There is a large range of emollient products available for a customer to choose from. Some points to
consider when helping customers choose between the different products are as follows:
• Lotions are readily absorbed into the skin and do not leave it feeling greasy, but would be used mostly
where skin is not very dry
• Creams absorb into the skin relatively quickly but are greasier and thicker than lotions. Some creams may
contain sensitisers, ingredients that can result in an allergic reaction in some people e.g. preservatives
used to prolong the life of cream
• Ointments are the heaviest, greasiest product. They are better for very dry skin but may not be as
cosmetically acceptable. It is thought they are effective for longer periods of times than cream and gels
• Pump dispensers may be easier to use than a large pot, and are often more hygienic
• Thick greasy emollients can act as insulators and therefore may be uncomfortable to use in hot weather
• A customer may like to use cream during the day and ointment at night, so may need more that one
product. Often, a person will use several different emollients for use on different areas of skin, in different
locations
Complete the following activities in your workbook to find out more about the products available to treat dry
skin.

So far, you have looked at the causes and symptoms of dry skin and its treatment.
It’s now time to focus on recommending products to meet the customer’s needs.
What to recommend
Having established that the customer is suffering from dry skin, you can recommend one of the products to
treat the condition and give some personalised and tailored advice. Remember using WWHAM will help you
establish the customer’s needs and CARE to provide advice about the treatment.

WWHAM WWHAM
customer

healthcare needs.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate

Advice
Advice and counselling points are included here, some or all may be useful for you to use with your
customer as part of finding the solution that best meets their needs:
• Smooth the emollient into the skin in downward strokes, following flow of the hair so that the skin
glistens
• Do not rub or massage as this generates heat and can cause itching or may block hair follicles
• Do not apply thickly as this can trap heat and cause itching
• Leave 30 minutes before applying other treatments
• Re-apply before the skin becomes dry
• Use a complete skincare regime such as bath and shower emollients instead of normal soaps
• Bath emollients can make the bath slippery so take care getting in and out of the bath
• The optimal time to apply emollients is after a bath. This helps to trap water into the skin and the warmth
of the skin makes application easier. Water trapping is enhanced if the skin is patted dry and left slightly
damp
• Avoid perfumed bath or shower products, which may irritate dry, sensitive skin
• Avoid soap as this causes dryness and can worsen the condition
• Apply emollients just before going to bed to reduce the likelihood of the skin becoming very dry overnight
• Children can wear cotton mittens at night to reduce scratching if itching is a problem
Prevention
Some or all of these points and suggestions may be useful for you to use with your customer, helping them
to avoid dry skin and promote healthy skin:
• Use an emollient regularly to prevent dry skin
• Use a complete skincare regime such as bath and shower emollients instead of normal soaps
• Avoid perfumed bath or shower products
• Avoid soap as this causes dry skin
• Use non-biological washing powder to minimise skin irritation
• Wear a good sunscreen in the summer to protect the skin from sunburn and to prevent the skin drying
out
• Wear cotton, silk or soft material next to your skin. Avoid materials such as wool, which can irritate the
skin
• Wear rubber gloves when washing up and cleaning to prevent the harsh chemicals coming into contact
with the skin

Dermatitis
Dermatitis is an inflammation of the skin, and is also called eczema. You may see the words used
interchangeably. There are several types of dermatitis however, it is generally grouped into two main types:
Atopic eczema
This can be described as dermatitis caused by a problem from within the body. It is a common condition,
which tends to run in families. This condition is dealt with separately later.
Contact dermatitis
This is dermatitis caused by a substance from outside the body. This typically causes patches of
inflammation on areas of skin that have come into contact with the substance. We will deal with contact
dermatitis in this section.
Dermatitis
What is contact dermatitis?

Contact dermatitis is inflammation of the skin that results from contact of an external substance with the
skin. There are two types of contact dermatitis, irritant and allergic dermatitis.
Allergic contact dermatitis

This occurs when the immune system reacts against a specific substance. The area where the dermatitis
develops can usually help pinpoint the cause. Allergic contact dermatitis usually occurs 48 to 72 hours after
exposure and will get worse or better depending on exposure.
Irritant contact dermatitis

This is caused by an irritant substance coming into frequent contact with the skin. People who do a lot of
cleaning, hairdressers, painters and bricklayers are particularly prone to contact dermatitis. The hands are
most commonly affected.

Causes
Some examples of possible causes of dermatitis are listed in the table below. Sometimes the cause is not
clear and tests are needed to find exactly what is causing the problem.
Allergic Contact Dermatitis Irritant Contact Dermatitis
• Nickel in metal and jewellery such as zips and studs on • Detergents and cleaning products such as washing-up
jeans, necklaces, bra straps watchstraps and earrings liquid, soaps and bleach
• Perfumed cosmetics and toiletries • Solvents
• Hair dyes • Oils and chemicals used in the workplace
• Paints • Paintbrush cleaners
• Latex and rubber such as rubber gloves
• Leather
• Cement
Looking at these lists you may be able to identify certain professions which will suffer from contact
dermatitis such as hairdressers, painters, catering, construction and healthcare workers.
Symptoms
Symptoms can range from mild to severe and may include the following:
• Redness and inflammation
• Severe itching
• Dryness and flaking
• Cracked skin covered with tiny blisters
• In severe cases a painful burn with blistering
• Prolonged exposure can make the skin thicker and scaly
When to refer
• Anyone under the age of 10 years
• If the affected area is the face or genital region
• If the skin is broken or weeping
• If the skin is infected
• Women who are pregnant or breastfeeding
• Anyone who has a nut allergy as some of the treatments may contain nut oil
When to recommend?

7
W
+ W Dry skin
Less than two weeks

WWHAM
H
A Nothing tried

Treatment
The treatment for both allergic contact and irritant contact dermatitis is the same. It is also important to try to
identify the cause and avoid it in future or protect oneself from contact with it.
Emollients
For any dry skin condition emollients are an important part of the treatment. Refer back to the dry skin
treatment section and the activity you completed for information about emollients.
Corticosteroid (hydrocortisone)
Topical steroids are very effective in treating dermatitis. They reduce inflammation in the skin and can be
used in combination with emollients. Although hydrocortisone can be sold to customers OTC there are a
number of restrictions attached to its sale:
• Can only be sold for use in adults and children 12 years and over
• Duration of treatment is limited to a maximum of one week
• It cannot be used on facial skin, the anogenital region, broken or infected skin
All preparations containing steroids should be applied sparingly (thinly) to the skin and to affected area(s)
only.
Information
For sales involving hydrocortisone cream you need to give your customer the following information:
•
•
Should not be used on the face or private areas of the body or on broken, infected or weeping skin
Should not be used for longer than 7 days
i
• Should not be used by anyone under the age of 12 years
• See the pharmacist if pregnant or breastfeeding
Complete the following activity to find out more about the treatments available in your pharmacy.

So far, you have looked at the causes and symptoms of dermatitis and its treatment. It’s now time to focus
on recommending products to meet the customer’s needs.
What to recommend
Having established that the customer is suffering from dermatitis, you can recommend one of the products
to treat the condition and give some personalised and tailored advice. Remember using WWHAM will help
you establish the customer’s needs and CARE to provide advice about the treatment.

WWHAM WWHAM
customer

healthcare needs.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate

Advice
• Dermatitis will continue unless you can identify the cause and avoid contact with it
• Apply a large amount of emollient cream regularly (every 2-3 hours) in addition to using a steroid cream
for treatment
• Wearing cotton mittens at night will reduce scratching and prevent further damage to the skin
Prevention
to avoid dermatitis and promote healthy skin:
• Identify the trigger for your dermatitis and try to avoid contact with the cause
• Don’t keep your hands in water for very long
• Use protective gloves wherever possible when working with chemicals such as detergents
• Consider using a barrier cream to help protect the skin on the hands when exposed to the irritant
• Use an emollient cream regularly to calm the itching and keep the skin hydrated
• Use a mild skin cleanser rather than soap to clean your hands
• Dry your hands thoroughly after washing
• Avoid perfumed bath or shower products
• Use non-biological washing powder to prevent skin irritation
Atopic eczema
The prevalence of atopic eczema in children may be as high as 20% and as many as 80% of eczema cases
first occur before five years of age. Most will grow out of it by their teens although in some people it will
continue when they are adults. People who have atopic eczema will have an increased tendency to develop
asthma and hayfever.
What is atopic eczema?

Eczema (also called dermatitis) is an itchy rash on the body. It is a chronic condition where sometimes there
will be no symptoms and sometimes it will flare-up. It is not contagious so other people cannot catch it.
Eczema

Causes
The exact cause of atopic eczema is not fully understood although people do have a tendency to inherit the
condition. Sometimes the symptoms flare up for no obvious reason but some of the triggers include:
• Chemicals, detergents, soap or shampoo
• Cosmetics and perfumes
• Inhaled irritants such as pollen or house dust mites
• Changes in hormone levels – eczema can be worse in women before their monthly period
• Cat or dog hair
• Certain foods such as dairy products
• Stress
• Dry skin
• Heat or cold
Symptoms
• Red, dry, very itchy skin mainly affecting the skin creases
• Small blisters particularly on the hands and feet
• Scaly areas of skin in places that are scratched frequently
• Usually affects the back of the knees and the inside of the elbows as well as the hands, feet, chest, face
and neck
When to refer
• If the affected area is the face or genital region
• If the skin is broken or weeping
• If the skin is infected
• Anyone who has a nut allergy as some of the treatments may contain nut oil
When to recommend?

W 7
+ W Dry skin
Less than two weeks

WWHAM
H
A Nothing tried

Treatment
Atopic eczema cannot be cured so treatment aims to control the symptoms. It is important that emollients
are used continually even when there are no symptoms to keep the skin hydrated.
The treatment for atopic eczema is the same as for contact dermatitis. Acute flare ups of eczema can be
treated with a steroid cream. Refer back to the Dry skin treatment section and the activity you completed for
information about emollients and the treatment of dermatitis section for more information on treatment with
a steroid cream.
Information
For sales involving a steroid (hydrocortisone) cream, you need to give your customer the following
information:
• Should not be used on the face or private areas of the body or on broken, infected or weeping skin
i
• Should not be used for longer than 7 days
• Should not be used by anyone under the age of 12 years
• See the pharmacist if pregnant or breastfeeding
Advice
• A bath about an hour before bed followed by plenty of emollient moisturiser can help cool the skin
• Wearing cotton gloves at night can help prevent scratching
Prevention
to avoid flare-ups and promote healthy skin:
• Avoid scratchy material such as wool next to the skin, wear cotton instead
• Avoid man-made fibres as these can stop the skin from breathing
• Cotton gloves worn at night can stop scratching at night helping to prevent infections
• Anti-allergy bedding will prevent dust mites causing eczema to flare up
• Use emollients every day even when there are no symptoms
• Keep finger nails short so scratching will not break the skin leading to infections
• Don’t have very hot baths and showers as this dries out the skin, have a cool shower instead
• Avoid soaps as these also dry out the skin, use a soap-free emollient wash
Complete the following activities in your workbook to learn more about the advice you can give to
customers suffering from atopic eczema.

Psoriasis
Psoriasis is a chronic skin condition and affects about 100,000 people in Ireland. It can occur at any time in
life. It is not contagious but it looks unsightly and often causes embarrassment to the sufferer.
What is psoriasis?
The normal process of skin renewal takes about three weeks but in psoriasis it is accelerated to about one
week. This causes a build-up of cells on the skin surface that are visible in layers. What triggers this
accelerated skin renewal process is not known. Psoriasis is a chronic inflammatory condition where there
are periods of time with no symptoms and then flare-ups of the condition.
There are different types of psoriasis. Normally, one type of psoriasis is experienced at a time, however, two
different types can occur together and the symptoms will vary depending on the type.
Common types of psoriasis include:

Plaque psoriasis – This is the most common type and will appear on the elbows, knees, scalp and lower
back.
Plaque psoriasis
Guttate psoriasis – Normally occurs following a bacterial throat infection and is often found in children and
teenagers and the sores which develop will be drop shape.
Scalp psoriasis – This will occur in parts of the scalp or across the whole scalp, with red patches of skin
covered in a silvery-white scale. This can be quite itchy.
Nail psoriasis – Nails will develop dents or pits and they can become discoloured and grow abnormally. The
nail can become loose.
Inverse (flexural) psoriasis – This occurs in folds and creases of the skin such as armpits, groin, between
the buttocks and under the breasts. Patches are red, large and smooth.

Causes
The cause of psoriasis is not known exactly, but it is thought that both inherited and external factors are involved.
• Lesions can develop at the sites of skin trauma such as sunburn and cuts
• Flare-ups can occur during periods of stress
• Some medication can cause or worsen psoriasis
Symptoms
• Raised red patches of dry skin covered with silvery scales
• Usually occurring on the elbows, knees and scalp
• Scalp psoriasis can be mild with slight redness through to severe cases with marked inflammation and
thick scaling
• Redness in scalp psoriasis often extends beyond the hair margin and is commonly seen behind the ears
Treatment
There is no permanent cure for psoriasis. As it is a persistent chronic disorder requiring the supervision of a
doctor you must always refer any customer who thinks they have psoriasis or who you think may have
psoriasis to the pharmacist. In addition to emollients, other OTC products available are based on coal tar or
combinations of coal tar and salicylic acid for patients who have previously been diagnosed by the doctor.
Emollients
Emollients are useful for mild psoriasis to help soften and soothe the skin and to reduce cracks and dryness.
Customers may need to try several emollients before finding the one that is the most effective for their skin.
They should be applied regularly and can be safely used by all customers. Refer back to the dry skin
treatment section and the activity you completed to see the wide selection of emollients available.
When to refer
• Anyone who thinks they have psoriasis but has not had it diagnosed by their doctor
• Anyone you think may have psoriasis but has not had it diagnosed
• Anyone taking medication from the doctor
• Anyone requesting Dovonex Psoriasis Ointment or where Dovonex Psoriasis Ointment is considered appropriate
When to recommend?
Customers with confirmed psoriasis who want to purchase some OTC medication
7
W
+ W Raised red patches of dry skin covered with silvery scales on the elbows, knees or scalp
No set timeframe
WWHAM
H
A Nothing tried
customers should be referred to the pharmacist.

Keratolytics (salicylic acid, lactic acid)

These ingredients are added to some emollients to help clear the scaling, which can develop when psoriasis
flares up.
Coal tar
Coal tar is effective in treating psoriasis. Most customers can use the majority of products on either the skin
or scalp. They can cause local irritation and stain skin and clothes. The products available OTC contain
different strengths of coal tar.
Calcipotriol Ointment
Calcipotriol is a Vitamin D analogue e.g. Dovonex Psoriasis Ointment 50mcg/g. It is used to treat mild to
moderate plaque psoriasis. Calcipotriol works by slowing the production of skin cells. You will be familiar
with this product from the SOP OTC Protocol 3 for Dovonex Psoriasis. When a customer requests this
product, you should gather the answer to all of the WWHAM questions from the customer, and then consult
with the pharmacist. If the pharmacist feels the product is suitable for them, the following points should be
included in the counselling provided, as part of the CARE framework.
••• C Counsel:
• Is only suitable for adults aged 18 years and over, for the treatment of mild to moderate psoriasis
which has been previously diagnosed by a doctor.
• It should be applied once daily to affected areas on the trunk and limbs only. Maximum weekly use
should not exceed 100g. Customers should be reminded to wash their hands after use and not to
use the ointment before a bath or shower. The ointment should NOT be covered by any occlusive
bandages.
• Skin irritation, redness and itching are the most commonly reported side effects.
• Customers should be reviewed by their doctor at least once a year.
x A Avoid:
• It is not suitable for customers with psoriasis affecting the nails, psoriatic arthritis
• It would not be suitable if the customer is pregnant, breast-feeding or planning to become pregnant
• Customers should be advised to avoid excessive exposure to natural and artificial sunlight and UV
lamps during treatment.
• Calcium or vitamin D should not be taken when using this ointment.
R Read:
• Read the patient information leaflet prior to using the medicine
! E Escalate:
• They should see improvements after 4 weeks of treatment. If satisfactory improvement is not noticed
within 12 weeks, they should return to their doctor for further review
Complete the following activities in your workbook to help you learn more about psoriasis treatments.

Advice
• Take care when applying coal tar containing products as they are messy to use, have an unpleasant odour
and can stain skin and clothing
• Some bath additives can make the bath slippery so take care when getting in and out of the bath
• Try and identify what causes flare-ups and avoid the triggers if possible
• Exposure to sunlight may improve psoriasis and many people notice an improvement when they go on
holiday
Urticaria
About one in six people will have at least one episode of urticaria in their lives and it can affect anyone at any
time. It is also known as hives or nettle rash.
What is urticaria?
Urticaria is an itchy, allergic skin rash that develops suddenly. The rash may be triggered by an allergy or
other factors such as heat or exercise. The trigger causes cells in the skin to release chemicals including
histamine, which cause the rash. It is not normally serious and fades within a day or two although the itching
may be uncomfortable.
Urticaria rash
Causes
In many cases the cause is not identified. Some of the common allergies that may trigger an urticaria rash
include:
• Food such as nuts, strawberries, dairy products, citrus fruit, eggs, food additives, spices, chocolate or
shellfish
• Insect bites and stings
• Medicines such as penicillin, aspirin or anti-inflammatory painkillers
• Pets
• Heat or exercise
• Cosmetics, ointments or chemicals
• Plants and nettle stings
• Vaccines and some viral infections

Symptoms
The rash usually appears suddenly and can affect any area of skin. It normally lasts for 24 to 48 hours
• Raised, bumpy weals normally 1-2 cm across but they can vary in size
• Each weal is red or white and surrounded by a small area of redness
• Weals can be any shape but are normally circular
• Intense itching
When to refer
• If the rash has lasted for longer than 48 hours
• Anyone who has anaphylaxis – severe swelling or difficulty breathing
• If the tongue or throat are swollen
• Anyone taking prescribed medication
When to recommend?
Any customers with acute urticaria
7
W
+ W Itchy rash with raised weals on the skin
Up to 48 hours
WWHAM
H
A Nothing tried
Treatment
Often no treatment is necessary as the rash commonly goes within 24 to 48 hours. You can recommend
treatment to ease the symptoms.
Antihistamines
Antihistamine tablets work quickly to control the symptoms by blocking the effects of histamine. They have
very few side effects. Some antihistamines are available in a syrup formulation for children or customers
who cannot swallow tablets. See the Hayfever section for more information on antihistamines.
Older antihistamines such as chlorphenamine can cause drowsiness.

Antihistamine tablets are not suitable for women who are pregnant or breastfeeding. !

Advice
• A cool bath or shower may calm the skin and soothe the itching
• Calamine lotion will help calm the itchy skin
• Try to identify the cause, for example if you suspect a food may be the trigger, keep a food diary of all the
things you eat and noting what kinds of food cause the reaction
Prevention
The following point may be useful for you to use with your customer, helping them to avoid urticaria and
keep healthy:
• If you can identify the trigger you can avoid it in the future to prevent further episodes
Dandruff
Dandruff is very common and affects both sexes and all age groups. The condition mostly occurs after
puberty, usually between the ages of 20 and 30. It responds well to treatment but will commonly recur if
treatment is stopped.
What is dandruff?
The skin on the scalp is constantly being replaced, just like the skin elsewhere on your body. Normally the
replacement is not noticeable except when it becomes excessive. The skin cells are shed in clumps big
enough to be seen as dandruff flakes, particularly when they land on dark clothing.
Causes
The reason for the increase in skin cell turnover is unknown. The current thinking is that dandruff is
associated with an overgrowth of a fungus commonly found on the skin and scalp, called Malassezia.
Symptoms
Most patients will diagnose dandruff without seeking medical help. The symptoms will be:
• Dry, flaky scalp
• Itchy scalp
• Visible dead skin cells on the clothing

When to refer
• If the scalp appears red – this could be seborrhoeic dermatitis
• If anywhere other than the scalp is affected
• Anyone who has already tried a medicated shampoo without success
• Babies and children
When to recommend?
Adults
7
W
+ W Dry, flaky, itchy scalp
No set timeframe
WWHAM
H
A Nothing tried
Treatment
The use of a hypoallergenic shampoo on a regular basis will control dandruff for most people with mild
symptoms, removing the flakes from the scalp. If this is not effective, a medicated shampoo can be
recommended to control the symptoms.
Ketoconazole
Ketoconazole is an antifungal ingredient available in shampoo formulations to control both the itching and
flaking associated with dandruff and it is also thought to have a preventative effect. To treat the dandruff, the
shampoo should be left on for a few minutes before rinsing. This should be repeated every 3 to 4 days for
between two and four weeks. It can then be used once every week or every two weeks to prevent the
dandruff recurring.
Coal tar
Medicated shampoos containing coal tar can be effective in controlling dandruff.
Selenium sulphide
Selenium has anti-fungal properties and is used to treat dandruff. It is available in a shampoo that can be
used for adults and children over the age of 5. It should be used twice a week for the first two weeks then
once a week for the next two weeks, thereafter as often as necessary to control the condition.
Selenium can cause discolouration of the hair and alter the colour of hair dyes. It may also
discolour metallic jewellery. It should not be used during pregnancy or if breastfeeding. !

Zinc pyrithione
This is an antimicrobial agent used in some medicated shampoos, which can be used by all customers of
any age. It should be used until the dandruff has gone.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate
Review the products on the back wall and in the healthcare area and complete the following activity in your
workbook.

products for your customer, name such products in your workbook.
Prevention
Some or all of these points and suggestions may be useful for you to use with your
customer, helping them to avoid dandruff reoccurring:
• Regular daily brushing of the hair prevents build up of skin cells
• Wash hair at least three times a week
• Use a specially medicated shampoo every 1 to 2 weeks
• Rinse hair thoroughly after shampooing
• Avoid using chemicals on the hair and scalp such as those used in hair colouring
• Spending time outdoorscan help, however, sun protection should be used to protect your skin from UV
rays
• Stress can be a trigger for dandruff, managing stress can help

Acne
Most people affected by acne are aged between 12 and 25 although men and women in their thirties and
forties can also suffer. It is very common and affects 80% of people at some time. Young women often have
intermittent acne caused by changes in hormone levels during their menstrual cycle. Most people will know
they have acne but may ask for your advice for a suitable product recommendation. There are many
treatments available OTC and from the doctor to help deal with the condition.
What is acne?
Acne is a disorder of the skin’s sebaceous (oil) glands. Hormones in the body cause excessive production of
sebum. This commonly starts at puberty when changes in hormone levels occur. The glands enlarge and
become swollen, the hair follicle gets blocked with a plug of dead skin cells. This appears near the surface
as a whitehead or, if it turns black, a blackhead. These blocked follicles are then prone to bacterial infections,
which will cause more swelling and redness. Acne can be classed as mild, moderate or severe with mild
acne being the only one that should be treated in the pharmacy without referral to the doctor.
Moderate Acne
Severe Acne

Causes
Acne is caused by the over activity of the sebaceous glands. The hormone responsible for the increase in
sebum production is testosterone, which is found naturally in both men and women. It is also thought that a
tendency to develop acne may be inherited from parents.
Symptoms
The most common areas of the body affected by acne are the face, upper back, shoulders and chest. These
are the symptoms you would expect to see, if a customer has:
Mild acne:
• A small number of blackheads and whiteheads
• Normally only the face will be affected
Moderate or severe acne:

• A large number of inflammatory, often painful, spots
• The acne will not be confined to the face
Only mild acne should be treated in the pharmacy.
When to refer
• Anyone who falls outside the normal age range
• Anyone with moderate or severe acne
• Anyone who has already tried OTC medication without success
When to recommend?
Teenagers and young adults
7
W
+ W Mild acne
No set timeframe
WWHAM
H
A Nothing tried

Treatment
Mild acne can be managed with OTC medication. In moderate or severe cases the doctor may prescribe
antibiotics and other topical preparations. Many medicated soaps and cleansers are available to use as part
of a daily routine to remove dirt and excess oil from the skin. Some may contain antibacterial agents such as
cetrimide or chlorhexidine. Exfoliating facial washes help unblock pores and reduce the likelihood of more
spots developing. These products may be used alone or in combination with acne treatments.
Review the products on your back wall and in the healthcare and skincare areas of your store and complete
the activity below in your workbook.
Benzoyl peroxide
This is available in preparations of different strengths so it is important to check the different products. It
works to reduce the bacteria involved in acne. It also has a keratolytic action and causes the outer layer of
skin, which is clogging the pores, to shed and reduces sebum. It is available as a gel and cream and should
be applied, to the whole affected area usually once or twice a day (depending on the product) for best
effect. It can cause drying, burning and peeling on first application. If this occurs then the product should not
be used for a couple of days until the skin has calmed down. It is a good idea to test the product on a small
area of skin before applying to a larger area to check for sensitivity. Patients should start on the lowest
strength and work up to a higher strength if needed. Benzoyl peroxide can bleach clothing and bed linen and
customers should be advised to wash hands after application.
Salicylic acid
This is normally found in washes or creams for acne. It has keratolytic action so it will also remove the top
layer of skin and break down blackheads and whiteheads.
Nicotinamide
Treatments that contain nicotinamides work by reducing inflammation, helping spots clear up faster and
reduce skin redness.
Complete the following two activities in your workbook which will help you learn more about these products
and how you can recommend them to customers.


products for your customer, such as:
• Tea tree
• Witch hazel
• Boots Witch Hazel Gel

So far, you have looked at the causes and symptoms of acne and treatments. It’s now time to focus on
What to recommend
When you have established that the customer, or person the customer is asking for, is suffering from mild
acne, you can recommend one of the products to treat the condition and give suitable advice to prevent
further episodes. Remember using WWHAM will help you establish the customer’s needs and CARE to
provide advice about the treatment.
WWHAM WWHAM

customer

healthcare needs.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate
Advice
• Acne is not caused by eating fatty foods or chocolate
• It can be triggered by exams, new relationships, pregnancy, some cosmetics and medicines
• It is not contagious, so other people cannot catch it

Prevention
to keep the skin healthy and prevent acne occurring:
• Do not pick or squeeze the spots as this may cause further inflammation and scarring
• Stress seems to make acne worse so try to avoid stress
• Wash your face, gently, twice a day with a mild cleanser - do not scrub your face as this will make the
acne worse
• Shampoo your hair regularly and try to keep your hair off your face
• Use a water-based moisturiser and make up. Greasy or oil based products block the pores, look for
products that are non-comedogenic (do not block pores)
• Try not to use make-up on affected areas
• A good intake of vitamins A, C and E, zinc and drinking plenty of water may help improve the health of the
skin
• Wash skin with lukewarm water, very hot or cold water can make acne worse
Warts
What is a wart?
A wart is a small benign outgrowth of skin, essentially the same as a verruca. Verrucas and their treatment
are covered in the Footcare section of this module.
Wart
Warts can appear singly or in clusters and, if left untreated, can last for a very long time. They can be found
anywhere on the body but are usually found on the hands.
Causes
A wart is caused by a virus that gets into the skin through a small cut, particularly if the skin is warm and
moist.

Symptoms
• Pale, raised, discrete spongy lesion with a cauliflower appearance
• Usually on the hands
• Tiny black spots in the wart may be visible, these are capillaries in the wart
When to refer
• If the wart is anywhere on the body other than the hands
• If the wart is itchy or bleeds or changes colour
• If the customer has diabetes or poor circulation
• If the customer is elderly
• If medication has already been tried without any improvement
When to recommend?
Adults and older children
7
W
+ W Small, raised, pale lesion with a cauliflower appearance
No set timeframe
WWHAM
H
A Nothing tried
Treatment
Most warts will disappear spontaneously in a few months but in some cases they may persist for years. The
aim of treatment is to destroy the growth and the virus that caused it. Depending on the treatment it can
take up to 12 weeks to be effective.
The products available work by destroying the infected skin. It is very important that they are used correctly
to ensure they are effective, and to prevent damage to healthy skin. Some wart preparations may also be
used for verrucas. Individual products will be labelled with directions for warts and verrucas as appropriate.

Salicylic acid products

There are many products containing salicylic acid in varying strengths and if used correctly they are an
effective treatment for warts. Salicylic acid acts by softening and destroying the skin. Some preparations
also contain lactic acid.
There are four simple steps to using salicylic acid preparations. The first two steps should be carried out
either on a daily or weekly basis, depending on product guidelines. Therefore, you must refer to the product
guidelines when recommending these products.
1. Soak the affected area in warm water and towel dry.
2. Rub the surface of the wart with a pumice stone or emery board to remove any hard skin.
3. Carefully apply the salicylic acid preparation making sure it does not cover any healthy skin around
the wart. When using liquid preparations it can be useful to cover the surrounding skin with
petroleum jelly, to protect it.
4. Repeat the procedure daily or as per product guidelines; remember it can take up to 12 weeks.
For further information on how to use salicylic acid preparations see the individual product patient
information leaflets.
Glutaraldehyde (Glutarol)
Application of glutaraldehyde is the same as salicylic acid but it should be used twice a day. It can cause skin
irritation and stains the outer layer of the skin brown.
Freeze treatment
These products work on the same principle used by doctors who “freeze” off warts and verrucas using liquid
nitrogen. Usually only one treatment is needed although it can be repeated for stubborn warts. They can be
recommended for customers over the age of 4 years.
Freeze treatments are not suitable for women who are pregnant..
!
Complete the following activity to learn more about the treatment of verrucas and remember when selling
these products to use CARE.

So far, you have looked at the causes and symptoms of warts and treatments. It’s now time to focus on
What to recommend
Having established that the customer, or person the customer is asking for, is suffering from a wart, you can
recommend one of the products to remove the lesion. It may also be of benefit to explain how long to use a
product e.g. those containing salicylic acid may need to be used for up to 12 weeks. Remember using
WWHAM will help you establish the customer’s needs and CARE to provide advice about the treatment.

WWHAM WWHAM
customer

healthcare needs.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate

Advice
• Do not pick, bite or scratch the wart as this may spread the virus and create more warts
• Correct use of the product is vital to remove the wart and prevent damage to healthy skin
• Put petroleum jelly or a dressing around the lesion before application of medication such as salicylic acid
to protect the healthy skin
• To speed up the treatment with the use of medication such as salicylic acid, file the surface of the wart
with an emery board to remove any hard skin and rinse thoroughly before application of the medication
• The treatment with salicylic acid may take up to 12 weeks and should be used every day to be effective

Ringworm
Ringworm is particularly common among children, but people of any age can catch it. Farmers and people
who work with animals that have fur have an increased risk of catching it.
What is ringworm?
Ringworm is not caused by worms but by a fungal skin infection. It can occur on the body or scalp. The
most common fungal skin infections you will come across in the pharmacy (other than athlete’s foot) will be
on the body and in the groin area. When the infection affects the body (trunk or limbs) it is called tinea
corporis. The infection of the groin area is called tinea cruris. The fungi that cause ringworm generally enter
the body through a break in the skin. If there is a scratch or cut, or if the skin is broken because of a
condition such as eczema, this can lead to an infection. Ringworm is also more likely to thrive in warm damp
areas; places where you sweat a lot, such as in the groin and under the arms and these areas are frequently
affected. It can spread to other areas of the body and sometimes the fingernails become infected. Fungal
infections that affect the groin area are commonly referred to as dhobi itch or ‘jock itch’. The rash is usually
isolated to the groin and inner thighs but can spread to the buttocks.
Ringworm on the body

Causes
Ringworm is a contagious fungal infection that can be caught from the following:
• Pets such as dogs, cats, hamsters and guinea pigs
• Farm animals
• Person to person contact
• Spread from other areas of the body
Symptoms
• Itchy, pink or red scaly patches with a well defined inflamed border on the body
• Itchy, reddish brown rash with a well defined edge in the groin area
• Patches on the body can range from a few millimetres to a few centimetres in size
• Scalp and beard infections may cause patches of baldness
• Nails with a fungal infection may become thick and discoloured
When to refer
• Where there is weeping, pus or yellow crusts. This indicates a secondary bacterial infection has
developed
• If the infection is widespread
• If a nail has become discoloured, thickened and brittle
• If the scalp is infected
When to recommend?
Customers with a small area of ringworm infection, but not affecting the scalp
7
W
Itchy pink or red scaly patches with a well defined inflamed border on body, reddish
rash with defined edge in the groin area
+ W
No set timeframe
WWHAM
H
A Nothing tried

Treatment
The same fungus is responsible for both athlete’s foot and ringworm, so the treatment is similar. Athlete’s
foot and its treatment is covered in the Footcare section of this module.
Imidazoles (miconazole, clotrimazole)

Most of the preparations available for treating fungal skin infections contain one of a group of antifungal
medicines called imidazoles. These are very effective in treating fungal infections by inhibiting fungal
growth. They should be applied two or three times a day and once the symptoms have cleared you should
continue treatment for a further one to two weeks.
Fungal infection of the groin

In addition to the imidazole antifungals there is another product terbinafine available to treat a fungal
infection of the groin (dhobi itch).
Terbinafine
This acts by killing the fungus causing the infection. Due to the mode of action the terbinafine product
available as a cream only needs to be applied once or twice a day for one week. Terbinafine cream is
licensed for the treatment of athlete’s foot and dhobi itch but can only be recommended for use in people
over the age of 16.
Complete the activity below to learn more about the products available for ringworm and remember when
selling these products to use CARE.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate

Advice
Advice and counselling points are included here, some or all may be useful for you
to use with your customer:
• Avoid spreading the infection to other areas of your body (and to other people) by touching the area as
little as possible, and washing your hands afterwards
• Keep affected skin clean and dry
• Don’t share towels and wash bedding and nightclothes frequently
• Wash the affected area thoroughly but gently, every day
• Change underwear and socks daily
• Avoid scratching and touching the affected area
• Pets also need to be checked and treated where appropriate, with a suitable veterinary/pet medicine, to
prevent repeat infection
Prevention
Some or all of these points and suggestions may be useful for you to use with your
customer, helping them to avoid getting ringworm and keep healthy:
• If you think your pet has ringworm, take it to the vet for treatment
• If any member of the household or a pet has ringworm, check the other family members for signs of
infection
• Do not share towels, clothing or bedding with anyone who has ringworm or other fungal infection such as
athlete’s foot
Boils
A boil can occur in anyone at any age. They are most common in teenagers and young adults.
What is a boil?
A boil is a bacterial infection of a hair follicle, which then spreads to the surrounding skin. They can develop
in any hairy area of the body, in particular where there is friction or where the skin is sweaty. If several boils
occur together this is known as a carbuncle.
Boil

Causes
A boil is caused by a high concentration of bacteria in one place. The following may increase the risk of
developing a boil:
• A lowered immune system caused by medical condition such as diabetes
• Skin conditions that cause you to scratch and damage the skin such as eczema
• Obesity
• General poor health or being run down and tired
Symptoms
Depending on the length of time the customer has had the boil, expect the following symptoms:
• Raised, red swelling, larger than an ordinary spot
• It will often have a yellow head caused by pus near the surface
• It will increase in size and become painful over a few days
• Finally it will burst and release the pus
When to refer
• Any customer asking for advice about boils
Treatment
Traditional treatment using a drawing ointment such as magnesium sulphate paste is thought to help. As
some people will require antibiotics to clear the infection or to have the boil drained by the doctor, it is better
to refer any customers asking for advice about a boil to your pharmacist.
Advice
customer:
• Small boils may subside and go without any treatment
• Keep the area around it clean using an antiseptic soap to help prevent it spreading
• Soak a clean cloth in warm, salty water and cover the boil for about 30 minutes, 3 to 4 times a day
• Do not pierce the boil and squeeze out pus as this can spread and cause more boils
• If you get recurring boils, it is important to see the doctor to find the underlying cause
Prevention
to avoid getting boils and keep healthy:
• Try not to get tired and run down
• Eat a healthy balanced diet
• Drink plenty of water

Excessive perspiration
Perspiration, or sweating, is the body’s way of cooling down and everybody sweats when they are hot,
although some people have more sweat glands and sweat more than others.
Excessive perspiration causes no medical problems but it can be embarrassing for some people.
Treatment
Many anti-perspirant products are available from the pharmacy in the deodorant section but specialist
products are available for customers who suffer from excessive perspiration.
Aluminium chloride (Anhydrol Forte)

This solution contain 20% aluminium chloride. It is applied to armpits, hands or feet at night and washed off
in the morning. It works by blocking the sweat glands. Check the packaging of the products so that you are
familiar with the directions for use of Anhydrol forte paying particular attention to how often it should be
applied.
These products should not be used on broken, irritated or recently shaved or wet skin.
!

Hereditary hair loss

Hereditary hair loss is a condition that affects most men and some women at some stage. Nearly all men
have some baldness by the time they are in their 60s. However, the age at which hair loss starts is variable.
In men about three in ten 30 year olds, and half of 50 year olds are quite bald. Some women also develop a
similar pattern of hair loss, usually around the time of menopause, but men usually experience more severe
hair loss. Becoming gradually bald is a normal part of the ageing process for most men and often no
treatment is wanted or needed. For some men and women affected, baldness can be distressing,
particularly if it is excessive or occurs early in life.
What is hereditary hair loss?

In men, typically, at first the hair begins to recede (thin) at the front. At the same time, the hair usually
becomes thin on the top of the head. A bald patch gradually develops in the middle of the scalp. The
receding front and the bald patch on the top gradually enlarge and join together. A rim of hair is often left
around the back and sides of the scalp. In some men, this rim of hair also thins and goes to leave a
completely bald scalp.

In women, the frontal hairline remains and there is a general thinning over all of the scalp that tends to be
more significant at the crown.
When to refer
• All customers who ask for your advice about hair loss
• If the hair loss is sudden or unexplained
• If the hair loss does not appear to be due to hereditary hair loss
• Anyone who is taking prescribed medication
When to recommend?
Customers who request a product by name for use in an adult aged 18-65
7
W
+ W Hereditary hair loss
No set timeframe
WWHAM
H
A Has used the product previously
Treatment
Treatment can usually prevent further hair loss, and often cause hair re-growth. Some products are also
available to help provide the micronutrients for good hair health and growth.
Minoxidil (Regaine)
This is available in regular (2%) and extra strength (5%) preparations. It needs to be applied onto the scalp
twice a day and usually takes 3 months or more for any effect to be noticed. Treatment needs to be
continued indefinitely. Any new hair that does re-grow usually falls out within a few months after treatment
is stopped.
Information
For sales involving products containing minoxidil, you need to give your customer the following
information:
• Only suitable for customers over the age of 18 and under the age of 65
i
• Should not be used if taking any other medication without checking with the pharmacist
• Should not be used by anyone who is pregnant or breastfeeding

Advice
customer:
• It usually takes 3 months or more for any effect to be noticed
• It is important that once started, treatment is continued indefinitely, as any new hair that does re-grow
usually falls out about two months after treatment is stopped

Complete the following activity in your workbook using, products available in the healthcare area, customer
leaflets, display material and other suitable reference source to help find alternative products for your
customer, such as:
• Boots Expert Hair Loss Treatment Spray for Women
• Nourkrin range of products


Back to Contents
Footcare
Module 2 Section 3:
There are many
“ problems that can affect

the feet and may
prompt your customers
to ask for your advice
and/or a suitable
“
product
recommendation.
Section 3: Footcare
Learning outcomes
• List the main causes of common foot conditions
• Describe the symptoms of athlete’s foot, fungal nail infections, verrucas, corns and bunions
• Describe personalised and tailored solutions for these customers, including advice on prevention and
wellbeing
• Recommend suitable products for customers suffering from common foot conditions

• Athlete’s foot
• Fungal nail infections
• Verrucas
• Corns and calluses
• Ingrowing toenails
• Bunions
• Chilblains
Introduction
There are many problems that can affect the feet and may prompt your customers to ask for your advice
and/or a suitable product recommendation. In this section we will learn about some of these conditions
however, it is important to know that for a particular group of customers you must always refer their
requests to the pharmacist.
Diabetes and footcare

People with diabetes are prone to foot problems, which can become serious. This is due to the fact that
they may have loss of sensation and poor circulation to the hands and feet. As a result of this they may
not be aware of damage to their feet, which can quickly become infected. So always ask if your
customer has diabetes and refer them to the pharmacist if needed.
Section 3: Footcare Healthcare Academy 81

Athlete’s foot
What is athlete’s foot?
Athlete’s foot is a very common, highly contagious fungal infection. It occurs between the toes and on the
soles of the feet.
Athlete’s foot
Causes
The fungus involved in athlete’s foot thrives in warm damp environments so sweaty skin encourages
infection. The area between the toes is perfect for the infection to develop and spread. It is passed from
person to person by direct contact or by contact with clothing and floors. It is often picked up from the
damp floor of a changing room or at the swimming pool.
Symptoms
Athlete’s foot normally starts between the toes. The skin appears red, itchy and scaly which then becomes
soft, moist and white with painful cracks. This can then spread to other areas of the foot or the toenails. So
your customer may describe any of the following symptoms:
• Itching between the toes and sometimes on the soles or sides of the feet
• Soggy white skin between the toes
• Flaking and peeling or cracked skin
• Red and inflamed skin
• Small blisters between the toes
• Thickened, yellow toenails if the infection has spread to the nails

Treatment
Many effective preparations are available to treat athlete’s foot. Treatment must be properly carried out to be
successful and to prevent the infection returning. Fungi reproduce by producing spores, which are shed into
the surrounding environment, where they can lie dormant for some time before growing into a new fungal
colony. In the case of athlete’s foot, spores are shed into socks and shoes so treating the socks and shoes
as well as the feet will help to prevent re-infection.
When to refer
• Diabetics – remember, never treat a diabetic customer with a foot condition
• Where the nails have become discoloured, thickened or brittle as this may indicate a nail infection
• Where there is weeping, pus or yellow crusts. This indicates a secondary bacterial infection has developed
When to recommend?
Any customer, but not diabetics
7
W
+ W Red itchy and cracked skin or moist white soft skin between the toes
No set time frame but symptoms will be seasonal

WWHAM
H
A Nothing tried
The treatment of athlete’s foot requires:

• Dealing with the fungus causing the infection by applying an antifungal preparation to the affected area
• Preventing re-infection by treating the socks and shoes
• Keeping the infected area clean and dry
Preparations for treating athlete’s foot

Cream
Cream preparations are used for treating the infection and are applied directly to the skin normally at night
and in the morning.
Powder
These are dusted in the socks and shoes to prevent re-infection. A powder alone used on infected skin
would be ineffective to treat the condition.
Spray
Spray can be used for the treatment of large or hairy areas or as an alternative to other products.

There are many different antifungal ingredients used in OTC preparations: Some of these preparations are
the same as those used to treat ringworm, which we looked at in the Skincare section.
Imidazoles (miconazole, clotrimazole)

Most of the preparations available contain one of a group of antifungal medicines called imidazoles. These
are very effective in treating athlete’s foot by inhibiting fungal growth. They should be applied two or three
times a day and once the symptoms have cleared treatment should continue for a further period of about
two weeks (depending on the product) to prevent reoccurrence of the infection. They can be used in adults
and children.
Terbinafine
This acts by killing the fungus causing the infection. Due to the mode of action the standard cream only
needs to be applied once or twice a day for one week to treat athlete’s foot. Residual levels of the antifungal
remain in the skin for a week after completing the course of treatment helping to prevent re-infection.
Terbinafine can usually be recommended for customers over the age of 16. It is also available as a solution
that is applied as a one-off treatment (Lamisil Once), which dries as a clear film releasing the active
ingredient over three days. Once in the skin it continues to fight athlete’s foot for up to 13 days. This
preparation can only be recommended for customers over the age of 18.
Tolnaftate
Products containing tolnaftate should be used twice a day and treatment should continue for at least two
week after the infection has cleared up. They can be used in adults and children.
Undecenoates
These substances prevent the fungi from multiplying any further and can be effective in treating athlete’s
foot. They must be applied twice a day and treatment continued for at least two weeks after the infection
has cleared up. They can be used in adults and children.
Complete the following two activities to learn more about the treatments for athlete’s foot.

So far, you have looked at the causes and symptoms of athlete’s foot and treatments. It’s now time to focus
on recommending products to meet the customer’s needs.
What to recommend
When you have established that the customer, or person the customer is asking for, is suffering from
athlete’s foot, you can recommend one of the products to treat the condition and a powder to treat the
socks and shoes to prevent re-infection. Remember using WWHAM will help you establish the customer’s
needs and CARE to provide advice about the treatment.

WWHAM WWHAM
customer

healthcare needs.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate


products for your customer, such as: Boots Alternatives Antiseptic Tea Tree Cream.
Advice
• Correct use of the antifungal product is vital to completely clear the infection and to prevent it coming
back
• Complete the course of treatment as indicated on the product, stopping early is likely to lead to re-
infection
• Dust socks and shoes with antifungal powder
• The feet should be washed and dried particularly between the toes before the antifungal cream is applied
• Keep a personal towel and do not share it to prevent the infection from spreading from person to person
Prevention
to avoid reinfection and keep healthy.
• Trainers and shoes made of synthetic materials should be avoided as much as possible as these do not
allow moisture to evaporate and create an environment for the fungus to grow
• Wear leather shoes where possible or open toed shoes in the summer to allow the skin to breathe
• Wash towels regularly
• Prior to putting on socks, tights or shoes, the feet should be dried fully
• Socks should be made from natural fibres such as cotton to allow the feet to breathe and they should be
changed daily
• Good foot hygiene is also important, feet should be washed daily with soap and dried thoroughly
• Athlete’s foot is easily transmitted and changing room floors in gyms, sports clubs and schools are likely
places to pick up the infection. Wear some form of footwear at all times to minimise the risk of infection

Fungal nail infections

What are fungal nail infections?
A fungal nail infection, also called onychomycosis, is an infection of the fingernails or toenails by fungi.
Fungal nail infections occur four times more often in toe nails than in finger nails. They are rare in children
and mainly occur in people over 55 years of age and in younger adults who share communal showers, such
as swimmers or athletes.
Causes
Customers who have fungal skin infections such as athlete’s foot are at risk of developing fungal nail
infections. The fungus involved thrives in warm damp environments so sweaty skin encourages infection.
The fungal infection is passed from person to person by direct contact or by contact with clothing and
floors. It is often picked up from the damp floor of a changing room or at the swimming pool.
In the case of nail infections the fungi penetrate cracks in the nail or enter through the soft tissue around the
edges of the nail. Nails which have been cracked or damaged as a result of an injury or nails which are
naturally fragile or weakened are easier for fungi to infect.
Symptoms
Fungal nail infections may affect just one nail or several nails. At first the nail may look thickened or
discoloured (whitish-yellow colour), particularly along the outside of the rim of the nail. The fungi can spread
into or underneath the nail, causing it to come away from the nail bed. The nail can become soft and
crumble and the skin next to it may be inflamed or scaly. If left untreated, the infection can destroy the nail
and the nail bed, cause loss of the nail and become painful.
When to refer
• Anyone who has two or more nails affected
• Where the diagnosis of fungal nail infection is uncertain
• When previous treatment has been unsuccessful
• Anyone who has a medical condition in particular diabetes - remember never treat anyone with diabetes who
has a foot condition
• Anyone under 18 years
• Anyone requesting a product containing amorolfine (Curanail)
Treatment
Fungal nail infections should be diagnosed by a healthcare professional. They can be difficult to treat and a
prescription only medicine may be required. In addition, the treatment will also need to be used/given over a
long period of time as it takes a long time for these infections to clear.
Amorolfine
You will be familiar with amorolfine, from the additional protocol Curanail(amorolfine) as part of the SOP-OTC
Policy for the Sale of Non-Prescription Medicines. Amorolfine is a fungicide that treats mild fungal nail
infections in adults, and only if up to two nails are affected. Amorolfine is available as a nail lacquer that is
applied once a week to the infection until the infection disappears. From the SOP OTC protocol for Curanail,
you will know this medication can only be supplied following your consultation with and authorisation from
the pharmacist. Discuss the protocol with your pharmacist and how the sale of amloforine should take place
in your pharmacy.

Treatments to remove fungal infected parts of nail

Some products contain a keratinolytic agent such as urea, which will soften the keratin in the infected nail,
allowing this to be removed so that the nail is then prepared for treatment with a topical antifungal cream.
Canespro Fungal Nail treatment set is an example of this type of product. Read the Patient Information
Leaflet for this product and discuss with your pharmacist how the sale of this type of product should take
place in your store.
Fungal nail pens

Various fungal nail pens are available to prevent and/or treat fungal nail infections. Some of these are
thought to work by reducing the pH value of the nail as it is thought that growth of fungi is reduced in acidic
or low pH environments. Many of the products available in the pharmacy to prevent or treat fungal nail
infections are classed as medical devices as opposed to medicines. The difference between medical
devices and medicines is discussed in the Foundation Module, refer back to this section to ensure you
understand what a medical device is.
Complete the following activity in your workbook to learn more about the products available for fungal
toenail infections and remember when selling these products to always use CARE.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate
Prevention
Good foot hygiene and prevention of athlete’s foot skin infections as detailed in the section on athlete’s foot
infections earlier along with maintaining a strong and healthy nail, by keeping nails clean and dry and
avoiding ingrown toe nails, will help avoid fungal nail infections and keep nails healthy.
Care must be taken when selling products classed as medical devices in the same way as products classed
as medicines, consider this while completing the following activity in your workbook.

Verrucas
What is a verruca?
A verruca (plantar wart) is a wart occurring on the sole of the foot. Both adults and children can have
verrucas although they are more common in children aged 12-16 years. You may see the plural of verruca
written as verrucas or verrucae, we will use verrucas throughout.
Verrucas can appear singly or in clusters and, if left untreated can last for a very long time. They are usually
found on the ball of the foot, underneath the big toe or on the heel. Warts on the sole of the foot have a
different appearance from warts elsewhere on the body because the pressure from the body’s weight
pushes the wart inwards.
Causes
Verrucas are caused by a virus that gets into the skin through a small cut, particularly if the skin is warm and
moist. They are usually picked up in changing rooms or around swimming pools.
Symptoms
• Flattened, pinkish, discrete spongy lesion on the sole of the foot
• Usually on the ball of the foot, underneath the big toe or on the heel
• Tiny black spots in the verrruca should be visible, these are capillaries in the verruca
• Sometimes painful when walking, as the verruca can press on the nerves in the foot
When to refer
• Diabetics –never treat a diabetic customer with a foot condition
• Any customer who complains of any symptom not listed on the previous page
When to recommend?

W
7
+ W Discrete lesion or lesions on the sole of foot with tiny black spots

WWHAM
H
A Nothing tried

Treatment
Verrucas may disappear spontaneously in a few months but in some cases they may persist for years. The
aim of treatment is to destroy the growth and the virus that caused it. Treatment can take up to 12 weeks
and should be used daily to be effective. All the products that are available to buy contain ingredients, which
work by destroying the infected skin. It is very important that they are used correctly to ensure they are
effective, and to prevent damage to healthy skin. Some preparations may also be used for warts, which are
covered in the Skincare section of this module. Individual products will be labelled with directions for warts
and verrucas as appropriate.
Salicylic acid products

There are many products containing salicylic acid in varying strengths and if used correctly they are an
effective first-line treatment for verrucas. Salicylic acid acts by softening and destroying the skin. The
preparations are available as liquids, ointments, gels, or medicated plasters. Some preparations also contain
lactic acid.
There are four simple steps to using salicylic acid preparations. The first two steps should be carried out
either on a daily or weekly basis, depending on product guidelines. Therefore, you must refer to the product
guidelines when recommending these products.
1. Soak the affected area in warm water and towel dry.
2. Rub the surface of the wart with a pumice stone or emery board to remove any hard skin.
3. Carefully apply the salicylic acid preparation making sure it does not cover any healthy skin around
the wart. When using liquid preparations it can be useful to cover the surrounding skin with
petroleum jelly, to protect it.
4. Repeat the procedure daily or as per product guidelines; remember it can take up to 12 weeks.
For further information on how to use salicylic acid preparations see the individual product patient
information leaflets.
Glutaraldehyde (Glutarol)
Application of glutaraldehyde is the same as salicylic acid but it should be used twice a day. It can cause skin
irritation and stains the outer layer of the skin brown.
Freeze treatment
These products work on the same principle used by doctors who “freeze” off verrucas and warts using liquid
nitrogen. Usually only one treatment is needed although it can be repeated at two week intervals for
stubborn verrucas. Some products can be recommended for customers over the age of 4 years, always refer
to the product information
Freeze treatments are not suitable for women who are pregnant.
!
Complete the following activity to learn more about these treatments.


So far, you have looked at the causes and symptoms of verrucas and treatments. It’s now time to focus on
What to recommend
Having established that the customer, or person the customer is asking for, is suffering from a verruca, you
can recommend one of the products to remove the lesion and explain the need to use some of the products
for up to 12 weeks e.g. products containing salicylic acid. Remember using WWHAM will help you establish
the customer’s needs and CARE to provide advice about the treatment.
WWHAM WWHAM
customer

healthcare needs.

CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate
Advice
• Correct use of the medicine is vital to remove the verruca and prevent damage to healthy skin
• Put petroleum jelly or a dressing around the verruca before application of the products with ingredients
such as salicylic acid to protect the healthy skin
• To speed up the treatment, file the surface of the verruca with an emery board or pumice stone to remove
any hard skin and rinse thoroughly before application of the medication
• The treatment with ingredients such as salicylic acid will take up to 12 weeks and should be used every
day to be effective
Prevention
The following point and suggestion may be useful for you to use with your customer, helping them to avoid
reinfection and keep healthy.
• As verrucas are often picked up at the swimming pool, wearing thin plastic socks (verruca socks) helps
to prevent the spread of infection
Use The Boots Healthcare Way to put into practice what you have just learnt about verrucas by completing
the following activities in your workbook.

Corns and calluses

Corns and calluses tend to be seen more often in older customers. It is estimated that 13% of all adults will
have suffered from corns in the last two years. Corns and calluses are much more common in women.
These conditions are not contagious and are easily treated.
What is a corn?
A corn is formed due to friction and pressure against a bony part of the foot. The outside layers of skin
become thickened over the bone following repeated friction. This produces a cone shaped nucleus in the
centre, which presses down on a nerve causing pain. The most common site for a hard corn is on the top of
the toes. Soft corns can develop between the toes due to friction between the knuckles of the toes. They
appear white and rubbery in texture and are kept soft by the moist environment between the toes.
Corn
What is a callus?
A callus is an area of hard dead skin caused by constant rubbing or pressure. It usually occurs on the sole of
the foot beneath a prominent bone. It is similar to a corn although it has no nucleus so will not cause pain.
The ball of the foot, outside of the big toe and around the side of the heel are all common sites for calluses.
Whilst they do not produce the pain associated with corns they may cause a burning sensation.
Causes of corns and calluses

Corns and calluses are most commonly caused by tight or ill-fitting shoes. The resulting pressure points lead
to a build-up of dead tissue.
Symptoms
Corns
Hard corns are normally located on the top of the toes whilst soft corns will normally be found between the
toes. A customer who has a corn may describe the following symptoms:
• Central core of hard grey skin surrounded by a ring of painful yellow inflamed skin
• Pain when pressure is applied
• Located over a prominent bone

Calluses
These can range in size from a few millimetres to much larger areas. They have no centre and have a much
less defined shape. A customer with calluses may describe the following symptoms:
• Flattened, yellow-white, thickened, insensitive skin
• No pain but sometimes a burning sensation
When to refer
• Diabetics – never treat a diabetic customer with a foot condition
• Any customer who complains of any symptom not listed above
When to recommend?
7
W
+ W Hard dead skin, sometimes painful

WWHAM
H
A Nothing tried
Treatment
The same types of products are used for the treatment of corns and calluses. Medication can be used to
remove the hardened skin and cushioning products will relieve the pressure. Files and pumice stones can
also be used to reduce the amount of dead skin.
Salicylic acid preparations

These are used in the same way as for the treatment of verrucas. The salicylic acid softens and gradually
erodes the skin. As for the treatment of verrucas it is important to protect the healthy skin around the corn or
callus.
Medicated plasters
These are used to remove corns. They contain salicylic acid in the centre to remove the hard corn and a felt
ring to relieve the pressure and discomfort.
Cushioning pads
These are available made out of several different materials such as moleskin, felt or foam and allow the
pressure to be taken off the corn or callus relieving the pain or burning sensation.

Medical devices
A number of products are available as medical devices. These products either work in one of two ways. One
way is the gel in the device softens the skin on the corn or callus, this softened skin can then be removed by
mechanical methods listed below e.g. Scholl 2 in 1 Corn Express Pen.
The other way is an acidic gel in a pen is placed on the corn, the top layer of the corn or callus will then peel
off. This results in a reduction of size of the corn and reduction in pan. The gel can be reused every four days
e.g. Boots Corn Removal All in One Pen.
Mechanical removal
Abrasive synthetic sponges, emery boards or a pumice stone can be used to rub the dead skin off. Special
blades to remove corns and calluses are normally available in the footcare section of your pharmacy.
These can be used once the corn or callus has been softened using a salicylic acid product. They must be
used with care to avoid damaging normal skin surrounding the corn or callus.

So far, you have looked at the causes and symptoms of corns and calluses and treatments. It’s now time to
focus on recommending products to meet the customer’s needs.
What to recommend
Having established that the customer is suffering from a corn or a callus, you can recommend one of the
products to remove the lesion, or cushioning to relieve the pressure and give personalised and tailored
advice. The following activity helps you to identify relevant products and advice.
Advice
• Protect the surrounding skin with petroleum jelly or a dressing before application of a salicylic acid
preparation
• To speed up the treatment, file the dead skin on the surface with an emery board or pumice stone to
remove the hard skin
• Soaking the foot with mild soap and water for 10 minutes prior to rubbing with a pumice stone (or similar)
for about 5 minutes will help soften the dead skin
• Prevention
• Some or all of these points and suggestions may be useful for you to use with your customer, helping
them to avoid the development of corns and calluses and keep healthy.
• Women often suffer with calluses on the balls of the feet caused by wearing high heels. Inserting a
cushioned pad, such as Boots Everyday Heels Gel Insoles, into the shoes can reduce this problem.
• Wearing properly fitting footwear will help prevent corns and calluses
• Regular trips to a chiropodist will help keep the feet healthy

Ingrown toenails
When part of the toenail penetrates the skin and causes a wound, it is said to be ‘ingrown’.
Ingrown toenail
Causes
Ingrown toenails usually develop when the toenails are not cut correctly and pressure from tight fitting shoes
pushes the nail into the skin. They are more likely to develop in older people as the toenail thicken with age.
Symptoms
• Pain at the corners of the nail
• There may be inflammation and redness, sometimes bleeding if the skin is broken
• An infection may develop where the nail penetrates the skin
When to refer
• Diabetics – never treat a diabetic customer with a foot condition
• Where the area appears to be infected
Treatment
• Wearing loose fitting shoes will remove pressure from the nail.
• The toenail should be thoroughly cleaned at least twice a day to help prevent an infection developing.
Surgical spirit can be used as an antiseptic.
• The skin can be pushed away from the nail gently using a cotton bud
• Painkillers can be recommended to those who have pain with the ingrown toenail
Prevention
To prevent ingrown toenails the following measures can be recommended to your customers:
• Ingrown toenails can be prevented by cutting the toenails straight across and by wearing suitable
footwear
• Make sure not to wear shoes that are tight fitting as this can cause overcrowding of the toes
• Make sure to keep the feet clean and dry to prevent infections

Bunions
What is a bunion?
A bunion is the result of displacing the joint of a toe, usually the big toe. It does not happen suddenly but is
caused by pressure on the foot, which slowly forces the toe into the wrong position over a matter of months
or even years. The big toe is pushed over towards the other toes, causing a deformity of the point between
the big toe and the foot.
To protect this protruding knuckle from friction, the joint becomes enlarged and produces a protective sack
of fluid (called a bursa). This hardens and becomes painful and inflamed. Bunions are ten times more
common in women than men, which is due to footwear choices.
Bunion
Causes
The cause is almost always directly related to the wearing of ill-fitting shoes although some people are more
prone to developing bunions than others. The feet of children and teenagers are more at risk because the
bones of the feet are more easily deformed than those of adults.
When to refer
• Anyone asking for advice about treatment of bunions should be referred to the pharmacist
Treatment
Bunions cannot be removed like corns and calluses. Special pads are available in the footcare section to
provide relief from the pressure.

Chilblains
This is an inflammatory condition of the feet. It may also affect the hands or occasionally the ear lobes. It is
most common in childhood and in older people. It may be associated with general poor health and can run
in families.
When the weather is cold, susceptible people will experience burning and itching on their hands or feet. This
is made worse by warming the affected area. The area will become red and swollen and in extreme cases
the skin may become broken.
Advice on prevention is important. A good diet, warm clothing, a warm environment and regular exercise to
stimulate the circulation will all help prevent chilblains.
When to refer
• Anyone asking for advice, or whom you suspect may be suffering from chilblains, should be
referred to the pharmacist
Varicose veins
What are varicose veins?
Veins are blood vessels which bring blood which has been travelling from the heart and to different parts of
the body, back to the heart. Smaller veins can be found outside of larger muscle areas in the body and this
results in the walls of these veins being weaker than other blood vessels in the body. For some people this
can mean that the blood flow may not always occur as efficiently as it should and this can cause blood to
pool in these veins. When this happens the feet and legs can swell and in some cases you can see the veins
on the legs, under the skin. This is caused varicose veins.
Causes
There are a number of risk factors for developing varicose veins which include:
• Genetics – varicose veins can be found in the same location as a person’s parent
• Gender - Oestrogen and progesterone, hormones linked to the menstrual cycle in women can cause
muscle to relax which facilitates pooling of blood in the veins
• Being overweight
• Prolonged standing
• Increasing age
• Injury
• Pregnancy - there is increased blood volume, and added pressure on the legs from the developing baby
as well as hormonal changes.

Symptoms
Varicose veins occur in approximately 30% of the population. For the majority of those affected they do not
cause a problems. However the following symptoms can be felt as the varicose veins develops:
• aching, heavy and uncomfortable legs
• swelling of the feet and ankles
• burning or throbbing in your legs
• itchy, dry skin where the varicose vein is located
Treatment
Compression hosiery does not treat varicose veins but provides symptomatic relief and may help prevent
further progression of the condition. Compression hosiery puts pressure on the ankle and lower leg to
prevent the blood from pooling in the legs and supports the veins to push the blood back towards the heart.
Compression hosiery in combination with the following can be used to provide relief for patients:
• Taking regular exercise
• Avoiding standing up for long periods
• Elevating the affected area when resting
Moderate to severe varicose veins or those which are painful or present with complications should be
referred the pharmacist. The pharmacist will decide on the most appropriate option for this patient, this may
involve a discussion around medical procedures sometimes referred to as secondary treatment options.
When to refer
• Anyone with moderate to severe varicose veins
• Painful symptoms with varicose veins
• Anyone taking any medication or has medical conditions
• Anyone who has just had surgery
• Anyone with unusual bruising
• Anyone with unusual bleeding
• If a patient has been referred by their GP
Complete the following activity to learn more about the compression hosiery service offered in your store.
Prevention
To help prevent the occurrence of varicose veins you can recommend the following to your customers:
• Do not stand still or sit for long periods of time, make sure to move around every 30 minutes
• Do not cross legs when sitting
• Exercise regularly
• When resting keep legs raised to improve the blood flow



Back to Contents
Parasitic infections
Module 2 Section 4:
In Ireland the common
“ parasitic infections you

are likely to come across
in the pharmacy are lice,
“
the scabies mite and
internal parasites such as
threadworms.
Section 4: Parasitic infections
Learning outcomes
• List the main parasitic infections you are likely to encounter at the healthcare counter
• Describe personalised and tailored solutions for your customers, including lifestyle advice
• Recommend suitable products for these customers

• Head lice
• Crab lice
• Scabies
• Threadworms
Introduction
In Ireland the common parasitic infections you are likely to come across in the pharmacy are lice, the scabies
mite and internal parasites such as threadworms.
There is still a certain stigma associated with parasitic infections, which, coupled with a general lack of
education about health matters, leads to myth and superstition. Customers will need careful, considerate
and, wherever possible, confidential advice on these problems.
Section 4: Parasitic infections Healthcare Academy 103

Head lice
What are head lice?
Head lice are small, blood sucking insects that live and feed on the scalp. They live close to the scalp and
therefore are not usually visible. The female louse lays her eggs on the hair at scalp level. After hatching the
white empty egg case is carried up to the surface by hair growth, where it becomes visible. These white egg
cases are more commonly referred to as ‘nits’.
There are many myths surrounding head lice.

• Lice cannot hop, jump or fly - the only way lice are spread is by direct head to head contact
• Lice have nothing to do with being dirty – they live on clean and dirty hair
• Lice do not prefer long or short hair – they live on hair of any length
• Lice are not just caught at school – they are often caught from adults who are not aware that they are
infested
Causes
Head lice hold on tightly to the hair usually close to the scalp, as this will offer them warmth, food and
shelter. They take between 6-14 days to become fully grown, and after this time they are capable of
reproducing. They need to maintain contact with a host in order to survive. Younger lice will usually remain
on the head where they have hatched for about 6 days, whereas fully-grown lice will often move from head
to head during close contact.
Nits (head louse egg cases)
Head louse on hair

Symptoms
Common signs of infestation include:
• Persistent itching of the scalp
• Restlessness
• Appearance of nits (empty egg cases)
• Black powder on the bedclothes especially the pillow (this is the digested blood excreted by the head lice)
By the time itching begins and nits are present, the infection has been present for some weeks.
When to refer
• Anyone who suffers from asthma
• Anyone who suffers from a skin condition such as eczema
• Anyone who has an itching scalp who has not seen any head lice or nits
• Children under one year old
When to recommend?
Adults and children over the age of 1 year
7
W
Confirmed presence of head lice with possibly presence of black powder on the
pillow, itching scalp
+ W
Several days
WWHAM
H
A Nothing tried

Treatment
There are a number of products available to treat head lice infestations. These include:
1) Products containing a traditional insecticide. The insecticides work by killing live lice, and may also kill
the eggs. However, the lice can develop resistance to these ingredients. The insecticides available
are:
• Malathion
• Permethrin
However, make sure to refer to the product packaging for each product.
2) Products containing a non-traditional insecticide. These work by killing live lice through a physical
action, they cover and drown the lice thus killing them. This means that the lice are less likely to
become resistant to them. These products are usually safe to use in children over 6 months old, but
always check product information.
These products contain ingredients such as:
• Dimethicone
• Cyclomethicone
• Isopropyl myristate
For most products used for head lice treatment a repeat treatments in the week or two following initial
treatment will be required if live lice are found on the head. Make sure to refer to the product packaging.
The products for the treatment of head lice are available as crème rinses, liquids or solutions, lotions, sprays
and a mousse.
The mousse and the lotions are alcohol-based and are therefore not suitable for asthmatics or
those suffering from a skin condition such as eczema. !
Complete the activity below in your workbook to find out more about the products available to treat head
lice.


Check out customer leaflets, display material and other relevant reference source to help find alternative
products for your customer, such as:
• Boots Electronic Head Lice Comb
• Tea tree oil
• Tea tree oil shampoo
• Boots head lice comb

So far you have looked at the causes and treatments of head lice. It’s now time to focus on recommending
products to meet the customer’s needs. Customers may feel embarrassed about asking for advice on head
lice, so remember to be aware of their needs when they approach you. If more privacy is needed then think
about a suitable area you can use to talk to your customer.
What to recommend?
When you have established that the customer, or person the customer is asking for, has head lice, you can
WWHAM WWHAM

customer

healthcare needs.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate
Advice
Here is some advice and some counselling points for customers who have head lice. You might find some or
all of them useful to use with your customer when you are finding the solution that best meets their needs:
• Lotions and liquids work better on dry, unwashed hair, so do not apply them to wet hair
• Allow hair to dry naturally after application, as using a hair dryer reduces the effectiveness of the product
• Protect the eyes with a pad and place a towel around the patient’s shoulders when applying the product
• Lotions are alcohol-based and are therefore flammable. They must never be used near a naked flame e.g.
an open fire, and a hair dryer should not be used
• Only treat when you find a living, moving louse. Check all close family and friends using the ‘wet
combing’ method (later in this Advice section). If anyone else is found to be infected they should also be
treated, to prevent re-infection
• Make sure you have enough product to treat all those infected, and carefully read and follow the
instructions on the pack. Pay particular attention to how long you must leave the product on for it to be
effective, and how often you may reapply the product
• The product used may not kill the eggs. The customer should check for lice hatching out from eggs 3-5
days after using the product, and again at 10- 12 days

Wet combing
Head lice are well camouflaged and will hide in the hair if disturbed during combing.
It is not always possible to see head lice during a quick inspection. However, the following method is
effective at detecting the presence of head lice:
1. Wash the hair using a normal shampoo and apply conditioner to the hair
2. Use an ordinary comb to straighten and untangle the hair
3. Once the hair is free of any tangles and the comb is moving freely through the hair, switch to using a
fine-toothed comb
4. Slot the teeth of the comb into the hair at the roots and bring it down to the ends of the hair – this
must be done with every stroke
5. Check the comb for lice after every stroke, and work through the hair section by section
6. Once all the hair has been worked through, rinse out the conditioner and repeat the process on the
wet hair
7. This can be done on a regular basis to allow for early detection and to prevent head lice from
spreading
Prevention
Some or all of the following points may be useful for you to use with your customer:
• Products available to treat head lice will not prevent re-infection
• If there is known infection, e.g. at school or nursery, using the wet combing method each night will allow
for early detection. Removing the lice present will ensure they are unable to lay their eggs overnight
• Inform all close contacts if head lice are found, to prevent the possibility of re-infection
Complete the activity below in your workbook using the Boots Healthcare Way to put into practice what you
have just learnt.

Crab lice
What are crab lice?
The pubic louse is also known as the crab louse because of its shape.
Causes
The crab louse lives on coarse body hair, which includes:
• Pubic hair
• Hair on legs and arms
• Underarm hair
• Chest hair
•
The crab louse is very contagious. It is often caught during sexual intercourse but it is possible to catch
them through accidental contact with infected people.
Symptoms
The symptoms of crab lice infection are:
• Intense itching
• Lice may be visible as brown/black dots
• Lice in the pubic area may cause specks of black powder in underwear – these specks are louse faeces
When to refer
• Anyone who suffers from asthma
• Anyone who suffers from a skin condition such as eczema
• Anyone with additional symptoms such as: genital sores, discharge or pain when passing urine
When to recommend?
Adults
W
7
TIntense itching, possible sighting of lice as brown/black dots, possibly specks of
black powder in underwear
+ W
Several days
WWHAM
H
A Nothing tried

Treatment
Creams, liquids, lotions and shampoos containing the same insecticides as those for head lice are used. The
same restrictions of use apply as for head lice. You will need to check which products are licensed to treat
crab lice, and what specific instructions there are for their use.
Complete the following activity in your workbook and remember when selling these products to use CARE.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate

So far you have looked at the causes and treatments of crab lice. It’s now time to focus on recommending
products to meet the customer’s needs. Customers may feel embarrassed about asking for advice on crab
lice, so remember to be aware of their needs when they approach you. If more privacy is needed then think
about a suitable area you can use to talk to your customer.
What to recommend
When you have established that the customer, or person the customer is asking for, has crab lice, you can
recommend an appropriate product and give some personalised and tailored advice. Remember using

WWHAM WWHAM
customer

healthcare needs.
CARE CARE
••• C Counsel
x A Avoid
R Read
! E Escalate

Advice
Here is some advice and some counselling points for customers who have crab lice. You might find it useful
to use with your customer when you are finding the solution that best meets their needs:
instructions on the packet. Pay particular attention to how long you must leave the product on for it to be
effective, and how often you may reapply the product.
Scabies
What is scabies?
Scabies is an itchy condition of the skin caused by a tiny mite which is less than half a millimetre long. The
scabies mite can burrow into any part of the skin, but parts of the body which may be affected include the
abdomen, armpits, genital area, hands and feet. The neck and head are not usually affected.
Scabies can affect people of any age but is most common in children and young adults. It is highly
contagious and is spread by close physical contact, especially in overcrowded living conditions. There are
sometimes outbreaks in schools and residential or nursing homes. It can also be passed on by sexual
contact.
Causes
The female mite burrows into the outer layer of skin to lay its eggs. Once the eggs have hatched and grown
into mites, the skin produces an allergic reaction and intense itching develops.
Symptoms
The symptoms of scabies appear between 2 and 6 weeks after the person has become infected. Usual
symptoms include:
• Thin, light brown or silvery, wavy lines which usually appear on the wrists, elbows, or genitals, or between
the fingers. This is the burrow of the female mite
• Severe itching, particularly at night and after bathing, when the body is warm, as the infested person
develops an allergic reaction to the mites, their eggs and their faeces
• A rash, which does not always correspond to the site of infection. It consists of small red raised areas.
Intense itching makes the patient scratch the area, so often scratch marks can be seen
• A secondary bacterial infection may occur if scratching breaks the skin
When to refer
• Children under the age of 6 years

When to recommend?
Anyone over the age of 6 years
7
W
Severe itching which becomes worse when the body is warm e.g. at night, after a bath,
along with a rash and possibly thread-like burrows between the fingers
+ W
Couple of days
WWHAM
H
A Nothing tried
Treatment
There are two main types of treatment available over the counter for scabies. Both of them are applied to
the entire body excluding, in adults, the face and scalp but including palms and soles of the feet. It is
important to pay particular attention to the skin between the fingers and toes. All people in close contact
should also be treated at the same time, to prevent re-infection, even if they are not displaying symptoms.
Permethrin cream
This is the simplest treatment regime, and is also non-irritant. It should be left on for 8-12 hours and then
washed off thoroughly.
Malathion liquid
This should be left on the skin for 24 hours and then washed off thoroughly. Treatment should be repeated
after 7 days.

So far you have looked at the causes and treatments of scabies. It’s now time to focus on recommending
products to meet the customer’s needs. Customers may feel embarrassed about asking for advice on
scabies, so remember to be aware of their needs when they approach you. If more privacy is needed then
think about a suitable area you can use to talk to your customer.

What to recommend
When you have established that the customer, or person the customer is asking for, has scabies, you can
recommend an appropriate product and give some personalised and tailored advice. Remember using
WWHAM WWHAM
Advice
Here is some advice and some counselling points for customers who have scabies.
You might find some or all of them useful to use with your customer when you are finding the solution that
best meets their needs:
instructions on the packet. Pay particular attention to how long you must leave the product on for it to be
effective, and how often you may reapply the product
• All bed linen, clothing and towels should be machine washed after the treatment has been applied to
prevent re-infection. Any items that can’t be washed e.g. cushions, upholstery, etc., should be covered
with plastic for 72 hours to contain the mites until they have died
• If you take a warm bath prior to treatment, the skin should be allowed to cool before the treatment is
applied
• If you wash your hands during the period of treatment, then the product will need to be re-applied
• Itching may continue for up to three weeks after successful treatment. A cream containing crotamiton
can be used to relieve this itching

Threadworms
What are threadworms?
Threadworms are small internal worm parasites, and commonly affect children. The worms are small, round
and white, about 2-3cm long. They can sometimes be seen in faeces.
Causes
Female threadworms deposit their eggs around the anus. This causes intense irritation and itching.
Scratching the area contaminates the fingers with eggs. This means that eggs can now be transferred onto
surfaces that can come into contact with mouths such as toothbrushes, children’s toys, food, etc. and by
putting fingers into the mouth. Once the eggs are swallowed the infestation cycle starts again.
Symptoms
Symptoms of threadworm infection include:
• Irritation at the anus, especially at night
• Vaginal irritation in females
• Severe itching which is worse at night
These can all lead to loss of sleep.
In more severe cases the following symptoms may also be present:

• Diarrhoea
• Loss of appetite
• Weight loss
When to refer
• Children under 2 years old
When to recommend?
Adults
7
W
Itching round the anus that is worse at night, possible sightings of the worms in
the faeces
+ W
Couple of days
WWHAM
H
A Nothing tried

Treatment
There is one treatment you can recommend for threadworms.
Mebendazole
Mebendazole will kill the worms with usually just one dose and is suitable for adults and children over the
age of 2 years. Products available include Vermox tablets and liquid.

So far you have looked at the causes and treatments of threadworms. It’s now time to focus on
recommending products to meet the customer’s needs. Customers may feel embarrassed about asking for
advice on threadworms, so remember to be aware of their needs when they approach you. If more privacy is
needed then think about a suitable area you can use to talk to your customer.
What to recommend
When you have established that the customer, or person the customer is asking for, has threadworms, you
can recommend an appropriate product and give some personalised and tailored advice. Remember using
WWHAM WWHAM

Advice
Here is some advice and some counselling points for customers who have threadworms. You might find
some or all of them useful to use with your customer when you are finding the solution that best meets their
needs:
• Keep finger nails cut short
• Wear pyjamas or pants at night
• Have a bath or shower each morning and carefully wash the skin around the anus to remove any eggs
that may have been deposited during the night
• Have your own flannel and towel for your use only
• Change and wash clothes and bed linen as frequently as possible
• Vacuum and dust the bedroom thoroughly
• Discourage thumb-sucking
• Wash hand and finger nails and scrub with nail brush, after each visit to the toilet and before each meal
• Disinfect toilet seat and surrounding area including the door handle
• All members of the household should be treated, even if they do not show any symptoms, to reduce the
chance of re-infection
• Drug treatment alone will not get rid of the infection unless everyone in the household is following the
above hygiene measures
Prevention
It is not possible to prevent threadworms, but adopting good hygiene practices will minimise the chances of
infection. Children in particular should be taught to wash their hands after going to the toilet and before
meals. Kitchen and bathroom surfaces should be cleaned regularly.
Roundworms
What are roundworms?
Roundworms are much larger then threadworms and can be between 20-30cm in length. They live in the
intestine.
Causes
Roundworm is rare in developed countries such as Ireland. It is most common in warm, moist climates, so
the most likely time to contract roundworms is when travelling abroad.
A female roundworm found in the small intestine lays eggs that are passed out in faeces. The eggs remain
dormant in soil until larvae released by hatching of eggs are ingested and released in to the small intestine.
This happens through handling of the infected soil, poor sanitation, or inadequate personal hygiene. The
infection spreads in humans by eating food or drinking water containing worm eggs.

Symptoms
Symptoms of roundworm infection include:
• Respiratory problems (wheezing and coughing)
• Colic, occasionally with diarrhoea
• Fever in children
• Nausea and/or vomiting
When to refer
As roundworm infection is so rare in the Ireland, you should refer all customers complaining of these
symptoms to the pharmacist.
Complete the activity below to put into practice what you have just read.


Boots ROI Healthcare Assistant Programme Module 2

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Healthcare Advisor

Expert Customer Care

Our aim is to be the best pharmacy-led health and

Stage 2 Module 2: Introduction

Module structure and content

Causes and symptoms

Is there an alternative approach?

Personalised and tailored solutions

W Who is the medicine for?

H How long have they had the symptoms?

A Action taken already?

+ M Medicines they are taking?

Prevention and advice

Self-check and section review

Sources of help and information

Preparing for assessment

Hints and tips for success

Ask your colleagues for their hints and tips too.

Most people will suffer

“ from some form of

Module 2 Section 1: Gastrointestinal

• List the main causes of gastrointestinal problems

• Recommend suitable medicines to treat these conditions

• Identify when to refer customers with a gastrointestinal problem to the pharmacist

We will cover the following conditions:

Section 1: Gastrointestinal health Healthcare Academy 11

Indigestion and heartburn

• Loss of appetite Gall bladder

Section 1: Gastrointestinal health Healthcare Academy 12

+ W Indigestion symptoms mentioned earlier

Couple of days, with recurring intermittent symptoms

+ M Not taking any medication

Section 1: Gastrointestinal health Healthcare Academy 13

• Magnesium salts can cause diarrhoea

Which type of preparation would you like, liquid or tablets?

Section 1: Gastrointestinal health Healthcare Academy 14

Remember when selling these products to use CARE.

Activity 2.1.1 (15 mins)

Is there an alternative approach?

Section 1: Gastrointestinal health Healthcare Academy 15

The symptoms can be made worse by bending or lying down.

+ W Indigestion symptoms mentioned earlier

Couple of days, with recurring intermittent symptoms

+ M Not taking any medication

Section 1: Gastrointestinal health Healthcare Academy 16

Proton pump inhibitors

Remember when selling these products to use CARE.

Activity 2.1.2 (10 mins)

Section 1: Gastrointestinal health Healthcare Academy 17

When recommending products, think about the following points to cover.

Section 1: Gastrointestinal health Healthcare Academy 18

Activity 2.1.3 (10 mins)

Section 1: Gastrointestinal health Healthcare Academy 19

+ W Constipation symptoms mentioned earlier

+ M Not taking any medication

All other customers should be referred to the pharmacist.

Section 1: Gastrointestinal health Healthcare Academy 20

Activity 2.1.4 (15 mins)

Activity 2.1.5 (5 mins)

Is there an alternative approach?

Personalised and tailored solutions

Section 1: Gastrointestinal health Healthcare Academy 21

W Who - is the medicine for?

+ W What – are the symptoms?