Skin & Scalp Conditions

A blister is a raised area of skin that is filled with a clear liquid, or occasionally blood, over which the skin is intact. They form when that area has been damaged by pressure, chemicals that have been applied to the area, burns, insect bites, allergies, fungal or viral infections.

If no further damage occurs to that area then the skin over the fluid stays intact and unbroken and the fluid is gradually re-absorbed back into the surrounding tissue.

Blisters formed from pressure often occur on the feet, from new footwear or after a sporting activity, and from changing from casual summer shoes to more formal, constricting footwear. Blisters also occur from overuse, such as on the hands after repetitive actions with tools and devices, like from the handle of a spade after digging in the garden.

If the blister has been caused by friction or pressure, try to relieve the pressure by using padded dressings and bandages and soft footwear or protective gloves when undertaking activities that may cause further damage.  

When the skin has been damaged by a burn or from irritant substances, then it is important to cool the area or rinse away the irritant with cool water – if possible hold the blistered area under a running cold water tap, or use wet towels over the burned or damaged area, changing them frequently to ensure the irritant has been removed and the area cooled.

If blisters are as a result of an infection, bite or allergy, then consult your community pharmacist. They will be able to give you specific advice to treat the underlying condition and to prevent further blisters occurring.

The most important treatment for a blister is to avoid breaking the skin over the blister. The fluid that is contained in the blister will disappear over the next few days and no infection should arise if the skin surface is not further damaged. These blisters are generally only painful when pressure is applied to them.

If the blister breaks then there is a risk of infection developing. They are also generally much more painful and take longer to heal. It is important to gently clean and cover the area with a clean dressing, and observe the blister and surrounding skin for any signs of redness, blood or infection developing.

If you have an area that is prone to developing blisters then you can use protective dressings that pad and protect the area to prevent blisters occurring. Your community pharmacy has a range of dressings that are specifically designed to speed healing, as well as to prevent, protect and treat blisters.  

In order to prevent blisters and other skin damage remember to protect the skin with socks, soft comfortable footwear that is neither too large or too tight, and use gloves to protect your hands from friction and pressure damage, as well as from irritant chemicals.

Your community pharmacist is able to give you help and advice if you need to seek further help to treat the damaged or infected areas of skin affected by blisters.

The medical name for a boil is a furuncle. It is an abscess that forms at the bottom of a hair follicle when infected by a particular type of bacteria, Staphylococcus aureus.

When more than one hair follicle is affected, this forms a multi-headed abscess called a carbuncle. If the infection spreads beyond the area of the hair follicle, a serious infection called cellulitis can occur. You will need antibiotics to treat this condition successfully.

Boils are common in adolescents and may also be spread from person to person due to skin contact. People with undiagnosed medical conditions are also more likely to develop these skin infections, so it is important to get help whenever you suspect you have a boil or any bacterial skin infection.

A boil starts out as being tender in the infected area. It then becomes swollen, hot and painful. The infection may ‘come to a head’ where a yellow coloured top bursts through the skin, releasing pus. It may also subside over a few days, leaving the skin tender but intact. Boils and carbuncles that burst generally leave a scar and may recur in the same spot or in nearby hair follicles.

A boil that has come to a head may be pierced (lanced) with a sterile needle, allowing the pus and infected tissue to be released. Care must be taken not to put pressure on the boil as this may push the infection into the surrounding tissue. A single boil may be treated with antiseptic creams and thorough cleansing of the surrounding area with antiseptic skin cleansers.

If boils recur or a carbuncle develops, then it is best to see your doctor, as you may need suitable antibiotics to stop the infection recurring or getting worse. Some people find that shaving hairy areas leads to boils developing repeatedly, so care must be taken when using razors or shavers to prevent reinfection. It may be helpful to use an antiseptic preparation when shaving in order to prevent boils.

If you have had a boil, or believe that you or your family have a skin infection, see your community pharmacist as they can provide you with products to treat or prevent infection. They can also tell you if you need to see your doctor in order to get antibiotics for your skin infection, or if you may be at risk of medical conditions that result in increased infection.

Developing bunions is very painful as they change the shape of your foot. Painful feet affect you every time you stand, walk or run, so bunions can seriously limit your quality of life. Any foot pain needs prompt referral to a doctor.

Bunions result in the big toe pushing against the second toe. This may cause all of the other toes on that foot to be pushed out of line. A lump can then form on the edge of the big toe, which may then grow larger and fill with fluid. Bunions may develop in teenagers as well as the middle-aged and elderly, so good fitting footwear is a must at all times.

Bunions are caused by pressure from narrow toed shoes, which push the toes out of alignment. However, they may also be from abnormal bones in your feet. Women are more likely to develop bunions and if your mother or grandparents had bunions then you are more likely to develop them too.  

Bunions may occur in one or both feet and are aggravated by poorly fitting footwear – especially occupations that put pressure on the feet, such as ballet dancing. As your toes are pushed out of alignment, corns and callous can also develop. Eventually, if your feet continue to have undue pressure squashing them together, toes may overlap each other or form hammertoes (the front of the foot starts to resemble a claw shape).

Immediate treatment for bunion pain is to remove any constricting footwear as soon as possible, apply cool cloths or soak the feet in cool water to help ease the pain. Check the surrounding skin and under the toes to see if broken skin, sores or corns are developing. Broken skin may result in an infection and is best treated as soon as possible. Pain relieving medication generally helps ease the pain if taken regularly and at suitable doses, but should not be used to allow you to continue wearing footwear that causes the discomfort.

Severe and acutely painful bunions may need surgery to realign the toes and to reshape the affected joint. This usually limits but does not cure the pain in all cases. There is a risk of bunions returning after surgical removal if the cause of the bunion is not addressed.

See your community pharmacist about treating and easing bunion pain, or if you think you may be developing a bunion. They have products and advice that can assist with preventing undue pressure on the bones of the feet and toes, and can help you with care of your feet when you have a bunion. It may be helpful to use special padding or inserts purchased from your pharmacy as they can help to stabilise joints that may be starting to develop bunions.

Your pharmacist can also advise you if you need to see your doctor or a podiatrist, if you have any other condition affecting your feet, or if your ability to carry out normal activities is limited.

Chilblains are burning red areas that occur on the end of fingers, toes and other areas of the skin that have been exposed to the cold.  They generally occur a few hours after the exposure so you may not always recognise what is causing the itching and burning that usually always follows the damage from the cold.

When the extremities get cold, the blood vessels in these areas become smaller, and when the area warms up again, some of the blood is thought to ‘leak out’ into the surrounding areas causing pain, swelling and itching.

Unfortunately when a cold snap occurs, you may be unprepared for the temperature change, and not have suitable protection for the exposed areas of skin, starting the chilblain cycle.  

Some people are more likely to develop chilblains, and they should prepare for the possibility of weather changes causing circulation problems, and be prepared with gloves, scarves and hats to keep them warm.  This should prevent the blood vessels from tightening due to the cold, and then from rapidly opening up again, causing the damage resulting in chilblains.

Once exposed skin has chilled it is best to warm the area gradually, with warm water rather than hot, and gently rubbing or massage with simple moisturiser and emollients to prevent sudden temperature change.  Remember to cover the ear lobes if out in the chilly weather, and after exposure gently rub them with a moisturiser as well.

Once a chilblain has developed, the priority is to prevent the skin from breaking and infection occurring as well.  This is why it is important to prevent further exposure to the cold, so keep on covering the affected areas whenever the temperature drops rapidly, or when going outdoors in chilly weather.  It may take up to ten days for chilblains to heal, so you will need to persevere with any treatment that you are advised to use.

Your community pharmacist can advise you as to how to treat chilblains, help to heal the damage and how to prevent them occurring in the future.  If you have suffered from chilblains in the past then go and see your pharmacist to prevent repeated occurrences of this painful condition.

Dandruff is the term used to describe the shedding of large amounts of flakes of scalp from the scalp. It is particularly noticeable when we wear dark clothing because it shows as a shower of small white flakes.

Normally a small amount of flaking of dead skin occurs and it is removed either by brushing or shampooing them away.  

The increase in dead scalp flakes is usually caused by the scalp producing more layers of skin because it is affected by a fungal infection or from seborrhoeic dermatitis. Normally the skin covering the scalp falls off gradually and isn’t generally noticed on the clothing. When someone has dandruff caused by a fungal infection, the skin produces more flakes and the scalp is often greasy and itchy. Seborrhoeic dermatitis is related to eczema or psoriasis but affects areas producing sebum, such as the scalp.

People with eczema elsewhere on their body may also suffer from this inflammatory condition, which is also helped by antifungal treatments that treat dandruff.

Dandruff is generally worse in the winter months, as it appears to be relieved by exposure to sunlight. The condition may spread to other hairy areas, noticeably the eyebrows, eyelashes, face, armpits and groin.  Dandruff is not a contagious condition, so is not transmitted from person to person, and is not a reflection of personal hygiene.

Flaking skin on the scalp should first be treated with antifungal shampoos containing zinc, selenium or a specific antifungal agent called ketoconazole. The shampoo should be applied to the scalp and left in contact with the scalp for several minutes before rinsing off. If used in the shower then the scalp should be shampooed at the beginning and rinsed off at the end of the shower to allow reasonable contact time with the scalp. Shampoo containing zinc or selenium may be used daily if required, but those containing ketoconazole should only be used twice a week. All dandruff treatment should be continued for four weeks after symptoms have cleared, then may be used each week to ensure the symptoms do not recur. Ongoing treatment with shampoo or conditioning preparations that contain tar as an antiseptic may also be helpful.

If you or anyone in your family is bothered by flaking scalp then consult your community pharmacist. They can help with treatment and advice for this embarrassing condition, or refer you for further treatment if the condition becomes severe or appears to be unrelieved by treatment.

Although about five percent of the population suffer from atopic eczema, this chronic inflammatory skin condition has no known cure.

Atopic eczema commonly affects areas like the inner side of the elbows, knees, wrists and ankles and when exposed to aggravating factors, the condition will flare-up and the skin will become itchy, red and inflamed.

The exact cause of atopic eczema is unknown. It is thought to be an inherited condition and if you have a family history of eczema, you are more likely to develop the condition yourself. If you suffer from atopic eczema you are also more susceptible to other allergic conditions, such as asthma, hay fever and allergies to food or the environment. These conditions often co-exist and can be aggravated by allergens, stress, fatigue or changes in weather.

Symptoms of eczema are a skin rash that might be inflamed, swollen, itchy, red, flaky or dry. When skin is dry and cracked it is more susceptible to bacterial infections, so the skin may also appear weepy, oozing or bleeding.

There are several options for effectively managing this condition. Corticosteroids are commonly used to manage mild to moderate eczema, but it is important that you ask your community pharmacist about using corticosteroids effectively. You should always try to use the lowest effective strength and use as little as possible. Corticosteroids must be applied sparingly to the affected areas and only when needed as they thin the skin.

If you get eczema on your face, it is important that only mild corticosteroids are used, as the skin in this area is thinner and more prone to absorption and local side effects. Stronger corticosteroids may be used on other parts of the body and during severe flare-ups.

Other treatments include:

• Antibiotics for secondary infections.. 
• Products to manage itchiness.
• Fragrance free moisturisers are essential in the management of eczema. Try to use moisturisers frequently throughout the day (and especially after showering) to moisturise the skin, to stop the skin itching and to protect against allergens.
• Soap substitutes, like aqueous cream should be used instead of soap to keep the skin moisturised and minimise dryness.

Eczema is influenced by lifestyle factors so ask your community pharmacist about managing your eczema. Some people develop flare-ups when there are sudden changes in the weather, so where possible try to anticipate changes in weather (for example, during travel) and prepare yourself with effective treatments.

Stress can also trigger flare-ups so try to avoid or manage stress as best you can. Stress management involves changing the stressful situation, changing the reaction if the situation is unavoidable, practising better health care and making time for rest and relaxation. Getting enough sleep is also an important factor. 

Also try to avoid known allergens, like dust mites, pollen and animals, and certain types of clothing, such as wool and synthetics. Some foods can also cause flare-ups - common food allergens include spicy foods, alcohol, food colouring, wheat, eggs, soy and peanut products.

Try to avoid long, hot baths and don’t scratch if you develop itchy rashes. Seek advice from your community pharmacist if you skin appears infected. 

Ingrown hairs appear as small coloured bumps under the skin. They may be either pink or brown coloured and may occur in clusters in areas where the skin is shaved or removed by waxing or other depilatories.

Consequently they generally occur in the face and neck in men; and the armpits, legs or the bikini area in women.

Ingrown hairs may also occur when hairs break off close to the skin because of friction from tight fitting clothing or when dead skin debris blocks hair follicles causing the hair to grow sideways instead of through the hair follicle.

Generally ingrown hairs occur more often after puberty, when the hairs on the face, armpits and pubic regions thicken and have more difficulty growing up through the hair follicle.

In order to treat an ingrown hair the hair follicle must usually be cleared in order to allow the hair to dislodge and grow straight again, as they do not usually resolve without some treatment. 

In most cases, thorough cleansing and gentle exfoliation will help to clear the blockage and allow the lump to subside, but in some instances of long standing ingrown hairs surgical removal may be indicated. 

The best treatment is to prevent ingrown hairs occurring in the first place.   Hydrating and softening preparations applied to the skin before shaving often prevents the hairs from ingrowing and prevents damage to the skin from the razor blade. 

After shaving and using depilatory preparations cleanse the area using gentle circular movements with a warm wet cloth or exfoliant, this also helps to remove any debris that may block hair follicles.

Your community pharmacist can give you advice on treating and preventing ingrown hairs as well as appropriate depilatory preparations to lessen the likelihood of their recurrence.

In severe cases hair follicles may become infected, but your pharmacist can advise if you need to seek treatment from your doctor or if they can solve your ingrown hair problems.

Your community pharmacist is an expert in treating and advising skin conditions, you can trust them to give you advice and solutions to solve your skin problems, or refer you to other treatment if necessary.

Measles is one of the viral conditions that used to be common in childhood.  It is spread from person to person by contact, such as coughing or kissing.

Generally infants are vaccinated for measles, mumps and rubella (German measles) at the same time in an MMR vaccination at 15 months and again between 4 and 5 years of age.  This means that most children are no longer at risk of catching this illness.

Outbreaks of measles do occur, and this often spreads rapidly amongst those who were not vaccinated or whose immunity is poor.

In susceptible children and adults, measles at its worst can cause some swelling in the brain, with serious side effects.  As this is a viral condition, antibiotics will not treat the virus, but antibiotics may be used to prevent catching a bacterial infection on top of the viral infection.

Symptoms of measles start with fever, cough, sore throat, sticky or itching eyes, and often sensitivity to light. By about the third day tiny white spots with a red circle around them usually appear inside the mouth.  Then a blotchy red rash appears, originating around the ears and spreading over the face and down to the body and the limbs.

Treatment is generally by keeping the child inside, away from the light, resting quietly, with (ideally) no other children about. Soft foods are often helpful for the sore throat and give paracetamol if the fever and headaches are bothersome.  Cough mixtures are no longer recommended for young children, so using vaporisers or steamy showers may help an annoying cough. Vaporisers are devices that you can buy or hire from pharmacies – they emit warm moist steam that helps to loosen phlegm and soothe an irritated throat.

If the eyes have a coloured or pus discharge then you must see a doctor as a bacterial infection may have developed.

As measles is a contagious disease children who have measles need to be kept away from other children until five days after the rash has disappeared. If there are other children in the family, see if your doctor recommends a booster vaccination for them, or attempt to keep them in a separate room as much as possible to limit contact and the chance of spreading the infection.

Your local pharmacist can give you advice about prevention and treatment of measles. If you are concerned about measles and its implications for your family then your family pharmacist has information and support about what to do in the event of an outbreak of measles or any other infection condition that may affect you or your family.

Burns are caused when your skin comes into contact with something too hot or too cold causing damage to one or more layers of skin. They may be caused by liquids (generally called scalds) or by being exposed to radiation, such as sunburn, as well as by electricity or chemicals.

The type of burn referred to as a minor burn generally only affects the top layer of skin and may be effectively treated without needing to see your doctor, provided the area affected is not large and the skin is not broken.

Minor burns are painful, they cause reddening and swelling of the affected area, but generally heal within a week, with the correct treatment.

The first think you need to do when the skin is burned is to cool the skin (or in the case of a freezer burn, to gently return the area to body temperature), so use tepid, not icy cold water, for at least ten minutes, to cool the area affected as soon as possible after the injury occurs.  A cool bath or shower is also effective to return the area to body temperature and limit the damage to surrounding tissue.

Do not use butter, oil or any greasy substance to soothe the area as this will keep the heat in and make it worse. After two or three hours and the affected area has cooled, a moisturiser could be used if the skin is not broken. The burn can also then be covered with a clean dry bandage or cloth, if on arms, legs, hands or feet. Minor burns to the body may be covered with light cool clothing. Small, minor burns to the face should be left uncovered if the skin is not broken so that further cool compresses may be applied if needed.

If the burn is painful, then taking a mild pain reliever such as paracetamol is often helpful, ensuring that the correct dose is given for that person.

If blisters develop then do not break the blister, but consult your community pharmacist, who will be able to advise you on either an appropriate treatment or advice, or may refer you to your doctor if required.

It is helpful to have simple first aid preparations available to treat minor burns and scalds on hand at all times, particularly in areas where burns often occur; such as the kitchen or when on holiday in the sun.  Consult your community pharmacist for the essential burn preparations to have in your first aid kit.

Moles are clusters of differently coloured cells on the skin. They may be large or small, flat or raised, dark or light, round, oval or irregularly shaped, and in most cases they are not sinister.

They may occur from damage to the skin, usually from the sun, and are especially common for pale skin. These moles arrive at some stage after birth and are called acquired moles.

Some people are born with hyper-pigmented skin areas, called birthmarks, or congenital moles.

Moles are really only a matter of concern when they change in appearance. It is helpful to know what moles and skin markings you have, so that you may determine if any changes are significant. It is best to check all of your moles at least once a year to note any changes.

There is a simple way to determine if any change to a mole is likely to be an issue, or a sign of possible melanoma, or skin cancer: the ABCD coding.

A = asymmetry, does one half of the mole look different to the other?

B = border, has the edge or border of the mole become irregular or blurry?

C = colour, has the colour changed, is the mole now unevenly coloured? 

D = diameter, has the mole become larger?

If any of the ABCD signs above have changed for any of your moles, then you need to seek some help from your doctor or pharmacist. If you are unsure if you need to get your moles checked then talk to your community pharmacist. They can advise you if the moles have changed and refer you for specialist help to get your moles treated.

If your moles have not changed, then congratulate yourself for passing the ABCD check, and continue to use sunscreen and protect your skin from sun damage in the future.  

Ringworm is a fungal infection caused by the tinea fungus, not a worm. It is spread by skin contact with someone who has the infection, or from a pet that also has this skin infection. The ringworm fungus can spread from one area to another if not treated, or from person to person.

The most common way to catch ringworm is from infected kittens or cats as children and adults hug and cuddle the animals, unaware that the pet has the infection.

Ringworm usually affects the skin on the arms, legs and body, but it can also spread to the scalp or other hairy areas. Infected skin has a round scaly patch, with a raised reddened edge and a paler centre. The rings of infected skin are often very itchy and if the skin is broken then further infections may develop on top of the fungal infection. Ringworm causes bald patches as the hair or fur falls out if the infected area is normally hairy in both animals and people. The hair or fur usually grows back once the infection has been successfully treated. More severe infections may also affect the nails which may discolour and thicken.

If you see an unusual rash on an area of skin or scalp, consult your community pharmacist immediately. Ringworm is easily diagnosed by examining the area. Once diagnosed in one person it is helpful to also look at the skin of other people that person is in contact with. You should also examine the skin and fur of any household cats and dogs, looking for bald patches, as they will also need treatment to prevent further infections developing.

Treating ringworm in the early stages before it spreads widely is simple and effective. Specific antifungal creams and lotions are used, depending on the area affected, and when applied regularly will clear an infection within a few weeks.

Widespread ringworm infections may need to be referred to a doctor as antifungal tablets may need to be prescribed. These medicines are very effective when taken as prescribed. If the skin has been broken and other infections have occurred on top of the ringworm, then antibiotics may also need to be prescribed to treat that infection.

Infected pets will need to be treated on the advice of a vet, not by using preparations for people, so do not share any ringworm medicine between animals and people. Don’t share any clothing, combs and brushes with someone who has ringworm, as this may also help to spread the infection to another person.

Your community pharmacist is able to advise you about the correct treatment of ringworm. They can also advise you how to keep you, your family and your pets free from reinfection.

Shingles or herpes zoster is a contagious viral infection that is related to chicken pox. Generally it affects people under stress or with poor immunity. Often those infected with shingles are already performing below their best and the pain from shingles is a further blow. It can  take some time to recover from the condition.

The virus that causes shingles affects a nerve either near the eyes or along the middle of the abdomen, causing small blisters to form. These blisters are very painful and may burst and take some time to heal.  However, for those that are already unwell when they develop shingles, the pain may last for many months after the skin has healed, while the nerve recovers. The pain, described as sharp or burning, is very distressing and may start before the blisters are noticed.

As soon as you believe that someone may have shingles they must see their doctor immediately. Prompt anti viral treatment will ease the nerve damage and help to prevent the pain lasting for as long. Effective shingles treatments are available from your doctor and must be taken for the full course of treatment.

Once shingles has been diagnosed it is important to start taking pain relieving medicine at once. Up to half of the people over 50 who develop shingles still complain of the pain a year after the visible signs of the shingles infection have gone.

As long term pain relieving medicines are required, advice from your community pharmacist can help you control the pain and prevent pain relievers causing further damage. Some specific post-viral pain relieving creams are available from your pharmacy and these may help to relieve most of the pain, allowing you to ‘top up’ with oral medicines as needed. 

Your local pharmacist can support and advise to manage and minimise the effects of shingles, and will refer you to further help if products you have tried have not worked to ease your recovery from this painful and debilitating condition.

We are often bombarded with messages about the dangers of sun exposure. And rightly so. With our high rate of skin cancer (melanoma in particular) it is often hard to fathom why we go out into the sun at all – especially during the summer months as we get enough vitamin D by doing outdoor activities outside of peak Ultraviolet Index (UVI) times.

Hundreds of people die of skin cancer every year and it is by far the most common form of cancer in this country. Our unique environment means we are particularly vulnerable to ultraviolet rays which cause sunburn. All types of sunburn, whether serious or mild, can cause permanent and irreversible skin damage and can lay the groundwork for skin cancer in later life.

Sunburn occurs when living tissue, like your skin, is overexposed to ultraviolet radiation (UVR) causing it to change in colour from slightly pink to severely red or purple. Sunburn can appear from one to six hours after exposure and the skin feels hot to the touch. Severe sunburn may cause blistered skin and even a fever, nausea and dehydration. Your eyes may also be painful or irritated due to overexposure to UVR. 

The best way to prevent sunburn is to use sun protection. It is particularly important to use sun protectionfrom the start of September until the end of March, especially between 11am and 4pm. Sunscreen is one type of sun protection - ask your community pharmacist which sunscreen is best for you.  You should also always wear protective clothing during this period, as well as a hat and sunglasses. In addition, try to keep in the shade whenever possible.

However, if you have the misfortune of getting sunburnt there are a number of ways you can help treat the condition:

• Use cold compresses on the burnt areas, for example a wet, cold towel.
• Ask your community pharmacist for topical treatments to manage the pain and heat, or a moisturising cream for  dry skin.
• If blistering occurs, do not burst them as you may get an infection. Instead cover with a gauze or a bandage. If your blisters do burst, see your community pharmacist for treatment options such as antiseptic ointment or hydrocortisone cream. .
• If you are in pain you can take aspirin, paracetamol or ibuprofen. Aspirin is not recommended for children.  Ensure you follow the directions carefully.
• Avoid alcohol and drink plenty of water to help rehydrate your body.
   

If the sunburn is severe, your eyes are extremely painful, or you have blisters accompanied by a fever or nausea, see your community pharmacist or doctor immediately. And remember that there is no such thing as a “safe” tan – any change in the colour of the skin is a sign that damage has taken place.