Skin Problems in the

Community Pharmacy
Your guide to mastering community pharmacy skills

Ahmed Hesham, Ph.D.

Outline
› Eczema/ Dermatitis
› Warts and Veruccas
› Corns and Calluses

AHMED HESHAM, PH.D. 2

 Eczema
(Dermatitis)

AHMED HESHAM, PH.D. 3

Overview
➢Eczema vs. Dermatitis: Terms often used
interchangeably. Dermatitis means skin inflammation.
➢Characteristics: Dermatitis presents as sore, red,
itchy skin
➢Common types in primary care are irritant contact
dermatitis (ICD) and allergic contact dermatitis
(ACD)
➢ICD is more common than ACD, accounting for 80%
of occupational skin disorders
➢ICD: Irritant must penetrate the stratum corneum to
trigger a reaction. Severity depends on the type,
concentration, and exposure duration
➢ACD: Requires sensitization; memory T cells trigger
an inflammatory response 24-48 hours after re-
exposure. Reaction may occur away from exposure
site. AHMED HESHAM, PH.D. 4
What you need to know…

•Common Irritants: Detergents, soaps, acids, alkalis, solvents,

oils, and reducing/oxidizing agents.
•Common Allergens: Nickel, chromate, topical corticosteroids,
cosmetics (fragrances, hair dyes), rubber, latex, and dyes.

Question Relevance
Rash in contact dermatitis often
Location aligns with areas affected by
clothing or jewelry.
Rash timing helps identify
cause; e.g., symptoms
Exposure worsening at work but
improving on holiday suggests
work-related exposure.
AHMED HESHAM, PH.D. 5
What you need to know…
➢Common Features: All dermatitis types cause
redness, dryness, irritation, and itching. Papules
and vesicles may be present; scratching often leads
to broken skin.
➢Chronic Exposure: Leads to dry, scaly, cracked,
or fissured skin.
➢Rash Location: Rash appears at the site of
exposure for both ICD and ACD.
➢Acute Phase: Lesions in ICD appear within 6–12
hours of contact; in ACD, lesions can appear up to
72 hours after exposure.
➢Rash Characteristics:
➢ICD: Rash is well-defined.
➢ACD: Rash is less defined; may spread mildly
beyond exposure site and reactivate on previously
exposed areas.
6
What you need to Eliminate …
•Urticaria:
•Commonly caused by food allergies, additives,
and medications.
•Rash is itchy, red, or white and surrounded by
redness.
•Appears suddenly and fades within 24 hours;
skin may be swollen and whitens when pressed.
•Treatment: Responds well to systemic
antihistamines.
•Psoriasis:
•Lesions appear red and scaly with minimal
itch.
•Distinct distribution from dermatitis, typically
unaffected by irritants or allergens.
•Does not respond to allergen or irritant exposure
as dermatitis does. 7
When to refer?
➢Evidence of infection (weeping, crusting, spreading)
➢Severe condition: badly fissured/cracked skin, bleeding
➢Failed medication
➢No identifiable cause (unless previously diagnosed as eczema)
➢No improvement after 1 week with topical corticosteroids
➢Children <10 years in need of corticosteroids
➢Lesions on the face, unresponsive to emollients

Treatment timescale

AHMED HESHAM, PH.D. 8

Management
Name of Use in Dosing & Instructions Restrictions
Medicine Children

Emollients From birth Apply liberally None

onwards whenever needed.
Perform a patch test on
the back of the hand
before use.
Hydrocortisone >10 years Apply twice daily for Use for max 1 week.
dermatitis. Use a Do not apply on face,
fingertip unit for anogenital region, or
Clobetasone >12 years
dosing based on body broken/infected skin.
part (e.g., 1 unit for
hand).

AHMED HESHAM, PH.D. 9

Warts and Verrucas
)‫(فالولة‬

AHMED HESHAM, PH.D. 10

Overview
➢Warts and Verrucas: Benign skin growths caused by Human
Papilloma Virus (HPV) with specific types preferring areas like
hands, face, anogenital region, and feet.
➢Spontaneous Resolution: Seen in 30% of people within 6 months
and two-thirds within 2 years; cosmetically concerning, leading
many to try OTC treatments before seeing a doctor.
➢Prevalence:
➢Most common in children (2%-20%) before age 16.
➢Rare in infants and older adults; caution if an older patient
presents with self-diagnosed wart.
➢Etiology:
➢HPV enters through skin defects; spread via direct contact or
contact with infected skin.
➢Environmental transmission is likely with macerated skin in rough
areas (e.g., swimming pools).
➢Autoinoculation: Picking or scratching warts can spread the virus,
creating multiple lesions. AHMED HESHAM, PH.D. 11
Overview
➢Differential Diagnosis:
➢Pharmacists must differentiate warts/verrucas
from similar-looking conditions.
➢Anogenital warts require referral, as they
are outside the community pharmacy's scope.
➢Clinical Features:
➢Warts: Appear on hands, fingers, knees;
raised, hyperkeratotic papules with black
dots (thrombosed vessels); usually rough,
skin-colored, and <1 cm in diameter.
➢Verrucas: Found on foot soles (weight-
bearing areas); inward growth due to
pressure, causing pain when walking;
visible black dots (thrombosed capillaries)
may be seen after removing hardened skin;
can coalesce into mosaic warts when
clustered. AHMED HESHAM, PH.D. 12
What you need to know…
Criteria Key Points
Age of Patient ➢ Warts rare in infants, common in young
children/adolescents
➢ Increased chance of seborrheic warts or
carcinoma with age.
Location ➢ Warts: hands/knees; verrucas: weight-bearing
parts of sole; face warts require referral due to
scarring risk.
Associated Symptoms ➢ Suspicious symptoms include itching/bleeding
(especially in older patients)- not associated
with warts and veruccas
➢ pain on walking often linked to verrucas.
Colour and Appearance ➢ Warts: cauliflower appearance, raised, pale;
➢ Reddish or color-changing warts need referral;
Raised, smooth with central dimple: could be
molluscum contagiosum 13
What you need to Eliminate …
➢Molluscum Contagiosum:
➢Caused by poxvirus, common in children under
5.
➢Appears as multiple lesions (1-5 mm) on face,
neck, or trunk with smooth, dimpled papules;
self-limiting.
➢Referral suggested if treatment is requested.
➢Corns )‫(بسمار لحمى‬
➢(NEXT TOPIC)
➢Plane Warts (Flat Warts):
➢Small (1-5 mm), often grouped on face and
hands; slightly raised, skin-colored.
➢Treatment can cause scarring on face, so refer
for facial warts.
➢Seborrheic Keratosis:
➢Benign, often appears with age; found on the
trunk, looks ‘stuck-on’ or waxy.
➢Typically brown but can vary from pink to
black. AHMED HESHAM, PH.D. 14
When to refer?
➢Changed appearance of lesions: size and colour
➢Bleeding
➢Itching
➢Anogenital warts
➢Facial warts
➢Immunocompromised patients (e.g Diabetic)
➢Patients >50 years presenting with a first-time wart

Treatment timescale
 Management
Medicine Use in Children Very Common Patients in Doses and Important Notes
or Common Whom
Side Effects Care is
Exercised
Salicylic Acid Depending on the Local skin Avoid in Soak the area, dry, remove hard skin.
product, some > 2 / > irritation diabetic Apply a few drops daily to the lesion.
6yo / No lower age patients Avoid unaffected skin.
stated

Salicylic Acid and Depending on the Use as salicylic acid products with daily
Lactic Acid product, >2 years / No application. No added efficacy proven
lower age stated with lactic acid combination.

Glutaraldehyde No lower age stated Local skin Apply twice daily, similar to salicylic acid
(Glutarol) irritation, skin application. Protect surrounding skin.
stains brown

Silver Nitrate No lower age stated Moisten pencil tip, apply to lesion for 1–2
min. Repeat after 24 hours; three
applications for warts, six for verrucas.
Avoid contact with surrounding skin.
AHMED HESHAM, PH.D. 16
Practical Points

➢Verruca vs. Corn:

➢Top layer removal can help differentiate; absence of black spots
suggests a corn.
➢Soaking the wart or verruca and occlusion the site by plasters may
improve cure rates
➢Higher salicylic acid concentration not necessarily mean it is more
effective.
➢If certain gels form an elastic film; remove before reapplying.
➢Application Tips:
➢Apply salicylic acid daily, preferably at night.
➢Soak affected area in warm water (5-10 min) to improve efficacy.
➢Remove dead skin with pumice or emery board; cover with
adhesive plaster for occlusion.
➢Protect surrounding skin with petroleum jelly to prevent
irritation
AHMED HESHAM, PH.D. 17
Practical Points

➢Podiatrists can offer guidance or treatments like cautery ‫كى‬,

curetting ‫كحت‬, or cryotherapy if OTC treatment fails.
➢Swimming Pool Guidance:
➢Waterproof plasters are advised.
➢Wear flip flops in communal areas.
➢Skin Cancer Awareness:
➢Non-pigmented lesions (e.g., squamous cell carcinoma): often
persistent ulcers on sun-exposed areas.
➢Pigmented lesions: Refer if changing size, shape, color, or
showing signs per ABCDE mnemonic (Asymmetry, Border,
Color, Diameter >7mm, Evolving).

AHMED HESHAM, PH.D. 18

Corns and Calluses
‫بسمار لحمي‬

AHMED HESHAM, PH.D. 19

Overview

➢Up to 18% of working adults report corns and calluses.

➢More common in older patients and women.
➢Corns: Caused by friction and intermittent pressure on bony
areas (e.g., heel, metatarsal heads), often due to inappropriate
footwear
➢Calluses: Formed by constant friction.
➢Diagnosis:
➢Primarily done by appearance; inspect the feet.
➢Differential diagnosis often between corns, calluses, and
verruca

AHMED HESHAM, PH.D. 20

Overview…
➢Clinical Features:
➢Hard Corns (Heloma Durum): Found on top of
toes, usually on the second toe; central hard grey
core with painful yellow ring.
➢Soft Corns (Heloma Molle): Appear between
toes, especially the fourth web space; remain soft
due to moisture, causing maceration.
➢Calluses: Size varies from a few millimeters to
centimeters.
➢Appear as flattened, yellow-white, thickened
skin.
➢Common in women on the balls of the feet;
also found on heel and big toe’s lower border.
➢Patients often report a burning sensation due
to fissuring of the callus.
AHMED HESHAM, PH.D. 21
What you need to know…
Question Relevance (Summarized)
Location Corns: tops or between toes;
Verrucas: plantar surface of foot
Aggravating/Relieving Corns: pain relieved by removing footwear;
Factors
Verrucas: pain persists with/without footwear

Appearance Corns/Calluses: white/yellow thick skin;

Verrucas: black dots (thrombosed capillaries)

Previous History Corns: history of foot issues, often due to

poorly fitting shoes; prolonged wear can cause
calluses/bunions

AHMED HESHAM, PH.D. 22

What you need to Eliminate …

➢Verrucas:
➢Often mistaken for corns or calluses; have a spongy texture
with tiny black spots in the center.
➢Rarely found on or between toes; more common in younger
patients than corns or calluses.
➢Bunions:
➢10x more common in women due to tight shoes.
➢Begins as bursitis of the big toe; inflammation leads to
hardening, forming a gelatinous mass in the joint.
➢Causes pain and difficulty walking in normal shoes.
➢Referral to a podiatrist is recommended.

AHMED HESHAM, PH.D. 23

When to refer?
➢Discomfort, pain causing difficulty in walking
➢Soft corns are present
➢Treatment failure
➢Impaired peripheral circulation (e.g., with diabetes)

Treatment Timescale
➢ Relief may be noticed in a few days to weeks
➢ When using keratolytics (e.g., salicylic acid-based treatments):
Visible reduction may take up to 2-3 weeks, but results vary and
treatment may be ongoing to manage symptoms.

AHMED HESHAM, PH.D. 24

Management and Practical Points
› Preventive Measures:
• Correctly fitting shoes are essential to prevent corn and callus
formation; open shoes like sandals or flip-flops can relieve
pressure.
• Salicylic Acid in Collodion-like Vehicle:
• Application: Once or twice daily for up to 14 days.
• Formulation: 11–17% salicylic acid in a volatile solvent (e.g.,
ether, acetone) forms an adherent film on drying, which holds
medication in place and aids in skin maceration.
• Caution: Avoid contact with adjacent normal skin; wash off
immediately if contact occurs.

AHMED HESHAM, PH.D. 25

Management and Practical Points
➢Salicylic Acid Plasters:
➢ Concentration: Usually 40% salicylic acid.
➢ Usage: Change every 1–2 days for about a week until callus or
corn lifts off.
➢50% Salicylic Acid Ointment:
➢ Application: Apply nightly for 4 nights to soften and lift the
corn or callus.
➢These treatments should follow instructions carefully to ensure safe
and effective use.
➢Soak the affected foot in warm water ----then remove the
macerated Soft white skin by gentle rubbing with a pumice stone

AHMED HESHAM, PH.D. 26

AHMED HESHAM, PH.D. 27
Attention!!!
Assignment number 2
➢Due on 2nd of November, 2024
➢Counts for 2 marks of your final grades
➢Any two submissions resemble each other will be deducted
marks
➢Assignment link:
https://forms.gle/wGKCo4UdHCjtCBAo6

AHMED HESHAM, PH.D. 28

References

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