Ask pharmacist Kathy Maher what ailments people present most with in summer and she immediately says “bites and stings”.
“We see lots of them. Sometimes people would pop in on behalf of someone else or with a photograph but ideally with skin conditions, it’s best if pharmacists see the person. If it’s a sting I’d like to see if the sting is still there. Same with a tick. Whatever it’s been, it’s easier to see if it has stayed localised or whether the sting or bite has gone into the soft tissue and if the area has become infected. We triage from there depending on the type of sting or bite. We’d know whether a simple treatment like an ice pack or washing the area is enough or whether a steroid hydrocortisone cream or an antihistamine is needed.”
Horseflies feature too.
“In midsummer you could have someone coming in because of horsefly bites. They tend to give a really nasty bite. Maybe people leave it a couple of days and maybe it has suddenly flared up or perhaps the soft tissue in the area has become infected. In that case we’d want to ensure that something like cellulitis or infection doesn’t develop. Seeing the person with the bite or sting is best.”
She often has someone coming in with a tick still in situ too
“We would be aware of Lyme disease and the importance of removing the tick very carefully,” she says. “We don’t tend to use tweezers. We’d use the edge of a bank card and just scrape because you don’t want to further damage the skin or release more [toxins] into the skin.”
Because many of their customers work outside, pharmacists see many people with heat rash and sunburn also, she says.
“It’s hard to know what causes heat rash. You could get a really bad heat rash here but go on holidays and not get one abroad or vice versa. For anyone with heat rash, depending on how severe it is and the location, we would always say wear light, loose cotton clothing in layers that you can remove, if necessary. Sometimes an antihistamine will help reduce itchiness or a vitamin C supplement can help because of its antihistamine and antioxidant properties.”
These occur mostly in July into August, but reports show that jellyfish are more plentiful than usual this summer.
“Our recommendation is to wash the area in as hot water as you can bear for about 30 minutes if you can, to rinse off as much sting as possible. Use an antihistamine cream if necessary, then reassess. The tingling might last for a number of hours afterwards. As a lot of these happen at weekends at beaches, pharmacies can be handy to pop into to seek advice.”
Hydration is key
To avoid skin irritations this summer – and to feel well – you should drink plenty of water.
“Rehydration is really important in the heat,” she says.
“We see a lot of symptoms happening at this time of year that are just down to dehydration – headaches, people feeling woozy, light-headed, often an older neighbour or relative might be a bit confused or lethargic and relatives come in, concerned about them. My first question would be: ‘Are they drinking much water?’ We could all improve on the amount of water we drink. [Urine being pale lemon in colour is a good indicator that you are drinking enough]. If an older person appears confused, often times we might just rehydrate with water or rehydration sachets and that might be enough to perk them up. Fluid intake is really important at this time of year for young babies as well. We would, of course, refer the person on [to a GP] if necessary.”
Dermatitis – management is key
When it comes to skin conditions like dermatitis, eczema and psoriasis, keeping the skin moisturised is key.
“Eczema is a form of allergic dermatitis. You are more likely to have eczema if you have hay fever and asthma and both of those conditions can flare up in the summer months. It’s really just about managing the flare-ups using emollients to really moisturise the skin. An antihistamine may help as well, but moisturisation is the mainstay of preventive treatment.”
She advises applying moisturiser as often as you wash your hands if you are having a significant flare up of dermatitis, eczema or psoriasis.
“Do it that frequently, each day. If you have one of these conditions it’s not unusual to use one or two of the big 500g tubs of Silcock’s Base emulsifying ointment or Aqueous Cream in a week. If they are put on your prescription, you can get them free on your medical card if you have one. They are included under the Drugs Payment Scheme, as well, if they are on your prescription.”
Be sun smart
It’s hard to write any article in summer without mentioning the importance of using sunscreen, she adds.
“June is Skin Cancer Awareness month. There are three types of skin cancer and we need to be on the lookout for them. Very regularly people come in to pharmacies and ask: ‘What’s this lump or bump?’ It might be a mole or skin tag that has changed. People like farmers who work outside or cyclists or those that jog a lot would be susceptible to skin cancer on the tips of their ears, head, face, nose and arms, so it’s very important that sunscreen is applied frequently. We see a lot of busy farmers who don’t stop to put on the sunscreen.”
Over 13,000 new cases of skin cancer are diagnosed in Ireland every year, according to the National Cancer Registry of Ireland.
Early detection is vital. If spotted early, up to 90% of cases are curable.
“10% of those cases would be melanoma, which is obviously the most serious type, but we also have basal cell and squamous cell and it’s really important that we get those seen to. We would refer the person to a GP if concerned. We can tell very quickly if it is something quite sinister.”
The treatment pathway is quick after that, she states.
“The GP will send a photo of the area to the dermatology clinic. They will assess it and, depending on that, they will call the person in and do a visual examination and decide whether it’s a watch and wait approach or whether it needs to be excised straightaway or the person referred on for further treatment.”
Be skin cancer aware: changes in moles to watch out for
Asymmetrical – a mole of concern has usually become asymmetrical.
Border – a melanoma often has a ragged or blurry border.
Colour – changes in colour warrant being checked out.
Diameter – or different from other moles. Increasing diameter can be a warning sign.
Evolving – the mole is changing in size, shape or colour.
The range of sunscreens is getting better, Kathy Maher says, meaning that men, including farmers, are more likely to use them.
“They are less fragrant and less irritating and less likely to make the eyes water and there are facial ones that are very light. Things are improving to make it [wearing sunscreen] more acceptable.”
But do you have to buy expensive sunscreens?
“We have to be practical because they can be expensive but a good quality sunscreen tends to be suitable for most skin conditions. Something like La Roche Posay, for hyper sensitive skin, could be €19 or €20 but that might be for 200-300 ml, which is a significant size. You can use sunscreen from last year unless it has been sitting out in the heat or in direct sunlight since then. Some people would have concerns about the SPF chemical in sunscreens but you have to balance that out with protecting your skin from the sun.
“I would recommend at least a factor 30 for Irish conditions for all skin types and a total block [factor 50] for children and anyone at risk, ie anyone elderly or with a previous history of skin cancers.”
Tips for those with skin conditions
A good tip around using sunscreen if you have a skin condition like dermatitis is to:
Remember that certain medicines can make the skin more sensitive to the sun so extra care should be taken and more sunscreen used.
“Some antibiotics, heart medications and some medicines for mood can leave the skin more sensitive to the sun, which can increase the chances of burning so when we dispense those we have to remind people of that.” Kathy – who is also Irish Pharmacy Union (IPU) chair of the Pharmacy Contractors Committee – believes that the COVID-19 pandemic has shown that pharmacies are “the open door”.
“They’ve shown how accessible a health profession we are. Cost may come into it for some who seek pharmacists’ advice rather than going straight to a GP but they know they can walk into a pharmacy on a Saturday evening and either be reassured or be referred on. We are the safety net and refer them on to a doctor or to hospital really quickly if necessary. As trained healthcare professionals we see all sorts from cardiac incidents to anaphylaxis to injuries. A village pharmacy is very much the hub of the community.”