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Skin in the game

By Fintan Moore - 01st Oct 2023

Years of experience as a community pharmacist have taught me how to recognise various skin rashes whether they be cold sores, shingles, or hand, foot and mouth disease, writes Fintan Moore

I don’t know if I missed a couple of relevant lectures when I attended third level, or if our syllabus was a bit deficient, but over the years of being a community pharmacist I have had occasion to learn how to recognise a few different skin rashes.

The most common is probably hand, foot and mouth disease, which can unhelpfully present on just a hand or foot or mouth – or any combination of the two. Shingles on the torso is usually easy to diagnose, but when
it crops up elsewhere on the body it can be trickier to spot, although if it is in or near the eye it is distinctive enough.

Whoever named Slapped Cheek Syndrome does not get any marks for imagination but that is exactly what it looks like. Juvenile Spring Eruption sounds like an out-of-control Leaving Cert holiday but it is actually an
itchy rash on the ears caused by a reaction to sunlight. And recently I had somebody in with Disney Rash which is a red and uncomfortable vasculitis seen in the feet or ankles, usually after a lot of walking in hot or humid weather, which people typically do in Disneyland.

Cold sores present an occasional problem for a large percentage of the population, but some people are afflicted several times a year. The sores are not just unsightly and painful, but the virus also poses a risk to very young infants and to the immuno-compromised.

Given the rate at which over-the-counter Aciclovir creams sell, it is surprising that there are so few prescriptions dispensed for antiviral tablets. There was a time that such tablets cost a small ransom, but those days are long gone, so price should no longer be a factor for private patients.

Obviously for GMS patients the cost was never a barrier, other than any budgetary impact. A useful and relatively inexpensive option for treatment is to use two doses of 2,000mg Valaciclovir 12 hours apart, taking the first dose at the first ‘tingle’. Keeping a course of tablets handy in the medicines cupboard avoids any delay in treatment.

For people who complain of recurrent sores it is worth suggesting that they discuss this course of action with their GP.

Medicines Shortages – Time for a rule change?

Dealing with ‘out-of-stocks’ has always been a perennial pain in the butt in the world of pharmacy and will doubtless continue to be so into the future. Rather than improving, it is likely that the problem will get significantly worse for the simple reason that medicine prices in Ireland are continuing to come down, so that other markets will be more profitable. Companies will understandably take the pragmatic view that in the event of any pressure on supplies it makes more sense for them to divert stock in a way that maximises revenue. Parallel exporting may further exacerbate the situation, but it is hard to know to what extent this might be the case.

I can’t fathom how any pharmacist could get enough stock to export any meaningful quantities given how miserly my own allocations are from both main wholesalers. Something would have to be pretty rotten in the system if medicine is exiting the country when I can’t even get enough stock to look after my patients. There is one obvious simple change that would help with medicines shortages, which is to get rid of the ‘10-day’ rule on returns. If that rule (which should never have been green-lighted in the first place) were to be removed, then any pharmacy with surplus stock of a medicine in short supply could simply return it to the wholesaler and back into the supply chain.

Of course, we all know that the chances of the rule being abolished, or even modified, are zero, but it is worth mentioning regardless.

SWITCHING OFF

One of the big differences between pharmacy life as an employee and pharmacy life as an owner is what happens when you go on holiday. Back when I was an employee a holiday involved me walking out the door without a backwards glance and forgetting that the place existed for the duration of the break. However, as an owner I find myself working longer hours in the run-up to a holiday to have as much as possible sorted

in advance of me leaving. Then while I’m away I don’t like to be out of touch, despite having total faith in the staff in charge. The curse of modern communication means that emails can be accessed any time that I am in a wi-fi zone and it takes a serious amount of willpower not to look.

I have got better at switching off over the years, and the one piece of advice I can offer to any owner is ‘Do not ring the pharmacy to check how things are going’. If the pharmacy needs you, the staff will contact you, so just leave them alone. If you phone them, then you will hear about minor issues that would have waited perfectly well until you returned home, but that you now need to think about. You live and learn!

Fintan Moore graduated as a pharmacist in 1990 from TCD and currently runs a pharmacy in Clondalkin. His email address is: greenparkpharmacy @gmail.com.

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