Making a product recommendation
Once you have used the WWHAM questions to determine that the customer has a fungal skin infection, it is important that they know they need to treat it promptly. This is because the infection can spread to other parts of the body or can lead to a further bacterial infection (especially if the skin is cracked) which can sometimes be quite serious.
Guideline recommendation
UK guidelines recommend that the first line treatment for fungal skin infections should be topical antifungal agents. This includes active ingredients belonging to the imidazole group, such as Clotrimazole (e.g. Canesten). Imidazoles work by stopping the production of a substance essential for the fungal cells to grow and are often referred to as ‘fungistatic’. These imidazoles also have some additional antibacterial effects. They should be used for two to four weeks to clear the skin and for a further one to two weeks after the skin has healed.
Other treatments include allylamines (e.g.terbinafine). These act as fungicidals, killing the fungi by stopping a substance essential for fungal cells to grow. These treatments should only be used for a maximum of one week.
For the treatment of sweat rash or athlete's foot, where there is associated irritated and inflamed skin, you can recommend an imidazole combined with a corticosteroid cream (e.g. 1% clotrimazole and 1% hydrocortisone in Canesten Hydrocortisone Cream). The hydrocortisone will help the customer to gain some relief from the inflammation, itching and redness and the antifungal starts to treat the cause of the infection. Imidazole treatments combined with a corticosteroid should only be used for a maximum of seven days and then after this, the customer could switch to another topical antifungal (e.g. a cream or spray) and use until the infection has cleared.
Understanding the sufferer
While some fungal skin infections, such as athlete's foot, are easy for customers to identify, this is not always the case with other types of skin infections. As the infection may be in a sensitive part of the body, such as the inner thighs/groin or in skin folds under the breast or stomach, sufferers may feel embarrassed about their problem. Customers may also have perceptions about their condition that make them feel uncomfortable. For example, people with sweat rash can feel they are unhygienic and worry that pharmacy staff will think they don't wash properly. Or jock itch sufferers can mistake the symptoms for those of a sexually transmitted disease.
This can all mean that customers find it difficult to talk about their symptoms, so you need to be discreet and reassure them that their problem can be easily treated. Also, you may have some tips to help them manage the condition in the future.
Click here for the Canesten Cream prescribing information
Click here for the Canesten Hydrocortisone Cream prescribing information