Major changes have occurred in recent years in the management of asthma. Available research shows that we have not been treating the condition properly for a long time, only focusing on symptoms. 11 Probiotics vs prebiotics: what’s the difference?
13 Dual action cough relief
A cough syrup combining a demulcent and an expectorant provides a distinct advantage for patients due to its dual action.
15 Factors affecting wound healing
Wound healing is a complex and dynamic process critical to restoring the integrity of the skin and underlying tissues after injury.
17 Tackling eczema in winter
Influenced by environmental factors, winter can be a particularly challenging season for many patients suffering from eczema.
EDITOR: Nicky Belseck
Email: nicky.belseck@newmedia.co.za
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19 Power of dietary supplements: who needs them and why Dietary supplements have gained significant popularity recently. Registered dietitian, Shani Cohen, discusses their importance and who may benefit from them.
21 Topical nasal decongestion: enhancing quality of life during the common cold
23 Spotlight on psoriasis: preventing patches of itchy, sore skin
In SA 2.9% of the population is estimated to suffer from psoriasis. Symptoms vary but are usually recognised by itchy or sore patches of thick, red skin with silvery scales.
25 Adherence key to acne improvement
Acne vulgaris is a common, chronic skin disease that often requires prolonged treatment. Good adherence to medication and adjuvants are associated with higher clinical improvement.
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Covid still deadlier than flu
While there seems to be a perception that SARSCoV-2 has mutated in such a way that Covid-19 is now no more serious than seasonal influenza. Data from the 2023-2024 winter season in the US shows that perception to be incorrect. In SA, while there are influenza vaccines available, no booster doses of updated Covid-19 vaccines are available, in either the public or private sectors.
The study found that in winter 2023-2024, the risk of death in patients hospitalised for Covid-19 was greater than the risk of death in patients hospitalised for seasonal influenza.
statistical power available in this study, there was no significant difference in risk of death among those hospitalised for Covid-19 before and during the JN.1-predominant era – suggesting that JN.1 may not have a materially different severity profile than the variants that immediately preceded it.
INTERESTING
TOPICS IN THIS MONTH’S ISSUE INCLUDE:
• The destructive ways we cope, is there a better way (page 7)
“Compared with a study using the same database and methods, the death rate at 30 days was 5.97% in 2022-2023 vs 5.70% in 2023-2024 for Covid-19 and 3.75% in 2022-2023 vs 4.24% in 2023-2024 for influenza. Both adjusted hazard ratios (HR) were statistically significant, with an HR of 1.61 in 2022-2023 and 1.35 in 2023-2024, with overlapping 95% CIs. Changes in either the SARS-CoV-2 or influenza viruses or in their care (eg, use of vaccines or antivirals) may influence the comparative risk of death each season. The findings should be interpreted in the context of nearly twice as many hospitalisations for Covid-19 compared with seasonal influenza during 20232024,” Xie et al. reported.
The results also showed that at the level of
• Manage asthma more effectively in winter (page 9)
• Dual action cough relief (page 13)
• Power of dietary supplements: who needs them and why (page 19)
• Adherence key to acne improvement (page 25)
CROSSWORD
CHALLENGE
Congratulations to the winner of Crossword #63 Thabang Maja. For your chance to win a R500 Woolworths voucher don’t miss this month’s crossword puzzle on page 26.
AUTHOR: Industrial psychologist Taegan Devar.
The destructive ways we cope: is there a better way?
In the helping professions such as doctors, nurses, pharmacists, psychologists, social workers, and caregivers, so much energy is devoted to assisting others that self-care is often neglected. This can lead to ‘quick fix’ coping mechanisms to squeeze a few drops of fuel into a tank that is running on empty, writes industrial psychologist Taegan Devar – managing director of organisational development company PeopleSmart.
These mechanisms are often Band Aids at best, a quick massage or a Netflix binge, or turning to destructive things like alcohol or nicotine. Unhealthy coping behaviours are often justified by healthcare professionals on the basis that they need a break from the stress of their work.
Of course, they do need and indeed deserve a break. But the menu of coping mechanisms that the media and boarder society serve up for people to choose from, is not providing the deep and thorough refuel that they so desperately need. In fact, it often makes matters worse as they battle addictions resulting in poor health.
UNDERSTANDING WHERE OUR COPING MECHANISMS COME FROM
CHANGING OUR COPING PATTERNS
Identify your coping tendencies: When facing a tough situation, what are the coping mechanisms you instinctively go to? Put another way, what do you numb the pain with? These urges can be key red flags during times of high stress, grief, or loss.
To understand our coping mechanisms better, we can reflect on what coping behaviours significant others in our lives – parents/caregivers, friends, and family – modelled to us when they were facing challenges. Did they discuss difficulties openly and with love and care? Did they get angry or even violent? Did they turn to substances or other destructive behaviours? Did they simply avoid the situation, or change the subject?
Ask for help: The biggest barrier to getting help is asking for it. For helping professionals, this can be particularly challenging as they are used to being the helpers and may view seeking help negatively. Professional support can help you understand your stress responses, identify destructive coping behaviours, and find healthier ways to deal with stress.
Learn healthy ways of framing and dealing with stress: Stress and challenges are inevitable. How we perceive them – whether as fixed, unavoidable obstacles, or opportunities for growth – is crucial. Learning healthy coping strategies, such as going for therapy, exercise, proper nutrition, meditation, medication when necessary, spirituality, and seeking support from others, can help us live more fulfilled and resilient lives.
Stress and challenges are inevitable. How we perceive them – whether as fixed, unavoidable obstacles, or opportunities for growth –is crucial
AFRISPACER™
AfriSpacer™ improves lung deposition of inhaled medication given by a metered dose inhaler. The AfriSpacer™ device makes taking medication from an asthma pump easier and more effective. Aerosolized medication in the air inside the spacer is breathed in efficiently to the lungs. Using AfriSpacer™, rather than a nebuliser, avoids contaminating the air with exhaled respiratory droplets. Young children can use the one-way AfriValve™, allowing them to inhale medication with normal breathing. AfriSpacer™ and AfriValve™ can be washed and reused, making it a safe, effective and durable product.
EMAIL: afsapartners@allergyfoundation.co.za
Public Hospitals and Clinics can order the Afrispacer through the EProcurement System (EPS) Private Hospitals can order @ www.afrispacer.co.za
Also available at:
• Spar Pharmacies
• Dis-Chem Online - www.dischem.co.za
• The Local Choice Pharmacies
pulmonology Education
Manage asthma effectively this winter
SA has one of the highest rates of childhood asthma in Africa, and teenagers are experiencing more severe asthma symptoms than ever before
Available research shows that we have not been treating the condition properly for a long time, only focusing on symptoms.1
Major changes have occurred in recent years in the management of asthma. All patients with asthma regardless of severity should now be treated with an anti-inflammatory drug, and no patients should be on bronchodilator therapy alone.
According to the Global Asthma Report from a sample of over 450 000 people, from 63 centres in 25 countries, the proportion of people with severe asthma symptoms not taking the corticosteroid was high in all ages. An average of around 45% of children, 60% of adolescents, and 55.5% of adults were not using correct regular anti-inflammatory therapy, with significantly higher rates of incorrect management in middle-to-lowincome countries, like SA. 2
Reliever pumps (short-acting beta-2 adrenergic receptor agonists and anticholinergics) relax airway smooth muscles resulting in quick symptom relief. However, treating asthma with bronchodilators alone may lead to complications, as the inflammation of the airway will persist, even when the muscle is relaxed.3
Controller medication contains steroids and are taken daily to control symptoms, reduce inflammation, and prevent asthma attacks.
Controller medications should be taken daily even when patients don’t have symptoms.
Significant confusion still exists about the appropriate use of medications containing combinations of inhaled steroids with bronchodilators. Combinations of an inhaled steroid with salmeterol can be used as controller therapy, whereas combinations of inhaled steroids with a rapid onset bronchodilator such as formoterol, can be used as controller therapy and reliever therapy (single maintenance and reliever therapy) or only when symptoms occur (as an anti-inflammatory reliever). The MIMS drug formulary has amended its classification schedule to clearly distinguish the controller and reliever medications from each other, allowing medical professionals to correctly prescribe medication for asthmatics.
Asthma management plans are an integral part of asthma management and can be downloaded free of charge from www.allergyfoundation.co.za. Patients must be educated on how to use their medication effectively to ensure optimal lung deposition. All children younger than three, and any adult with difficult to treat asthma, should be using a 500ml spacer device breathing through the mouthpiece. For very small infants of three years and less, a facemask is necessary, but should be removed as soon as the child is able to breathe in and out through the mouthpiece with a good seal between the lips and the spacer.
*References available on request
An estimated 1 000 people die from asthma every day, according to the Global Asthma Report.4 1000
nutrition & supplements Education
Probiotics vs prebiotics: what’s the difference?
While pharmacy personnel may encounter patients familiar with probiotics and prebiotics – usually due to doctor prescriptions – they might not fully understand their usage, purposes, and health benefits. Pharmacists can provide crucial information about the differences and benefits of probiotics and prebiotics.
PROBIOTICS VS PREBIOTICS
Probiotics are live microorganisms, known as ‘good bacteria’, naturally found in the intestines.1 They aid in digestion, nutrient absorption, disease prevention, and immune function. Poor diet, stress, and environmental factors can disrupt the balance between good and harmful bacteria in the gut, leading to health issues and immune dysfunction. 2 The human gut hosts about 100 trillion microorganisms, encompassing over 500 different species, typically without causing illness.1
Probiotics are available in various forms, including foods, drugs, and dietary supplements. Fermented foods like sauerkraut, kimchi, kombucha, and Greek yogurt contain live microorganisms that enhance gut health and survive the digestive process. Patients should introduce these foods gradually to allow their gut to adjust to new bacterial strains.3
In contrast, prebiotics are dietary components that promote the growth and balance of healthy bacteria in the colon. Prebiotic fibres are non-digestible, fermented into short-chain fatty acids in the colon, providing energy for gut cells.5 Prebiotics naturally occur in foods such as asparagus, Jerusalem artichoke, garlic, and whole wheat. Due to their low concentrations in foods, they are also produced on a large industrial scale using raw materials like lactose, sucrose, and starch. 4
HEALTH BENEFITS OF PROBIOTICS
Probiotics offer various health benefits, including:
• Antibiotic-associated diarrhoea: Probiotics help alleviate mild or severe diarrhoea caused by antibiotic treatments, which can disrupt normal gut microflora and promote the growth of pathogenic bacteria.5
• Infectious diarrhoea: Probiotics are effective in treating and preventing infectious diarrhoea, notably caused by rotavirus in infants, a significant cause of infant mortality. Probiotic supplementation in infant formulas aims to prevent such infections.5
• Inflammatory bowel disease (IBD): Probiotics can reduce symptoms of IBD, which includes conditions like Crohn's disease and ulcerative colitis, characterised by inflammation, ulceration, and gastrointestinal narrowing. Symptoms such as abdominal pain, diarrhoea, and gastrointestinal bleeding can be alleviated, and remission maintained through probiotic use.6
• Other potential benefits include immune system stimulation, protection against respiratory infections, cholesterol reduction, and anticancer effects. It's important to note that probiotic benefits are strain-specific, not species- or genus-specific.6
HEALTH BENEFITS OF PREBIOTICS
Incorporating prebiotics into the diet provides multiple health benefits, such as:
• Alleviating symptoms of peptic ulcers and vaginal mycosis 7 Pharmacists can guide patients on the appropriate use of probiotics and prebiotics to maximise their health benefits and support overall well-being.
*References available on request
Probiotics are live microorganisms, known as 'good bacteria',naturally found in the intestines.1
are
The human gut hosts about 100 trillion microorganisms, encompassing over 500 different species, typically without causing illness1
Prebiotics
dietary components that promote the growth and balance of healthy bacteria in the colon.
winter ailments Education
Dual action cough relief
The advantages of a demulcent and an expectorant combination for an acute cough
An acute cough is a common symptom of acute bronchitis or the common cold, often significantly impacting patients’ quality of life (QoL) and work productivity. Most cases are selflimiting and are of viral origin, making antibiotic treatment inappropriate due to side effects and resistance risks. Symptomatic treatment is preferred and often involves self-medication.
Cough acts as a defence mechanism to prevent harmful substances from entering the tracheobronchial tree and to expel secretions. Recent research focuses on the ‘urge to cough’ (UTC) sensation that precedes the motor act of coughing, indicating that sensory nerves in the pharynx might also trigger the cough reflex.
DRY VS WET COUGH
Dry coughs are usually caused by viral URTIs, acute bronchitis, irritants, and allergies, while wet coughs often result from URTIs, post-nasal drip, and pneumonia. The common cold typically starts with a sore throat and dry cough, progressing to a productive cough, and then back to a dry cough as the illness resolves.
DEMULCENTS
for Paediatrics with special focus on phytotherapy, advocates for demulcents like marshmallow root extract as a firstline treatment for cough due to their coating effect, which is beneficial for both children and adults.
EXPECTORANTS
Thyme herb extract is a herbal expectorant with secretolytic and mucolytic properties, which helps improve mucociliary clearance and has a spasmolytic effect to help open airways. Thyme has been used to treat various respiratory disorders for, including coughs from colds and bronchitis. Thyme extract stimulates bronchial gland function, reduces surface tension, and improves mucociliary clearance.
A herbal demulcent, marshmallow root extract is traditionally used for oral or pharyngeal irritation and associated dry cough
Marshmallow root extract (Althaea officinalis L.) is a herbal demulcent traditionally used for oral or pharyngeal irritation and associated dry cough. Demulcents like marshmallow root dry extract form a protective barrier on the pharynx, soothing inflammation and irritation, and relieving cough by coating sensory receptors to reduce the UTC. Marshmallow root dry extract has proven efficacy in reducing cough intensity and frequency across various clinical trials. Dr Peter Voitl, a specialist paediatrician, and paediatric expert for the European Medicines Commission
A cough syrup combining a demulcent (marshmallow root extract) and an expectorant (thyme herb extract) provides a distinct advantage for patients due to its dual action. The demulcent acts locally within the pharynx to reduce the UTC, while the expectorant works systemically within the lungs to thin and clear mucus. This complementary action effectively relieves both productive and nonproductive coughs.
SOURCE: The advantages of a demulcent and an expectorant combination for an acute cough – Inova CPD Article
ATURALINGRE
wound care Education
Factors affecting wound healing
Wound healing is a complex and dynamic process critical to restoring the integrity of the skin and underlying tissues after injury
Understanding the factors that influence wound healing is crucial for optimal patient care. This knowledge empowers pharmacists to provide targeted recommendations, identify potential complications, and optimise therapeutic outcomes. Here's a breakdown of key factors to consider:
1. INTRINSIC FACTORS:
• Age: Wound healing slows with age due to decreased cellular turnover, impaired blood flow, and altered immune function.1,2
• Nutritional status: Deficiencies in protein, calories, vitamins (particularly C and A), and minerals can significantly hinder healing.1,2,3
• Comorbidities: Underlying conditions like diabetes, cardiovascular disease, and chronic infections impede wound closure.1,2,4,5
• Medications: Certain medications, such as corticosteroids and immunosuppressants, can slow healing.1,2,6
2. EXTRINSIC FACTORS:
• Wound type and severity: Complex wounds (eg, diabetic foot ulcers, pressure injuries) present greater healing challenges.5
• Infection: Bacterial colonisation or fullblown infection delays healing and increases the risk of complications.2,5,7
• Blood supply: Poor perfusion due to peripheral vascular disease or venous insufficiency limits oxygen and nutrient delivery to the wound bed.7,8
• Moisture balance: Both excessively dry and overly moist wounds can impede healing.2
3. IATROGENIC FACTORS:
• Suboptimal wound care: Improper cleaning, dressing selection, or bandaging techniques can negatively impact healing.2
• Pressure on the wound: Constant pressure disrupts blood flow and hinders tissue granulation.7
OPTIMISING WOUND HEALING THROUGH PHARMACEUTICAL CARE:
Pharmacists can play a vital role by:
• Performing a comprehensive medication review: Identify medications that may be impairing healing and suggest alternatives if possible.
• Recommending nutritional supplements: Address potential deficiencies in vitamins, minerals, and protein to support tissue repair.
• Educating patients on proper wound care: Instruct on cleaning techniques, dressing changes, and signs of infection.
• Collaborating with healthcare providers: Communicate concerns about delayed healing or potential medication interactions. By understanding these factors and taking an active role in wound care management, pharmacists can significantly contribute to improved patient outcomes and faster healing times.
ADDITIONAL CONSIDERATIONS:
• Smoking cessation: Smoking significantly reduces blood flow and impairs healing.7 Encourage smoking cessation for better wound outcomes. 2
• Pain management: Uncontrolled pain can hinder mobility and impede wound healing. Advise on appropriate pain management strategies.
• Psychological Support: Chronic wounds can be emotionally stressful. Provide resources or referrals for psychological support if needed.
Remember, effective wound care requires a multidisciplinary approach. Pharmacists, by virtue of their medication expertise and patient interaction, are well-positioned to optimise wound healing and improve patient well-being.
*References available on request
4-12
A wound is chronic if it hasn't started to heal after 4-12 weeks despite treatment
Tackling eczema in winter
Influenced by environmental factors, winter can be a particularly challenging season for many patients suffering from eczema
Clinical observations and several studies indicate that a significant number of eczema patients experience a worsening of symptoms during the winter months.1,2 This increase in prevalence during winter underscores the need for heightened awareness and proactive management strategies.
Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterised by itchy, red, and dry skin. It affects people of all ages but is particularly common in children. 2
PATHOPHYSIOLOGY
Eczema is primarily a result of skin barrier dysfunction and an abnormal immune response. The skin's ability to retain moisture is compromised, leading to dry and cracked skin that is susceptible to irritants and allergens. During winter, the reduced humidity and cold air exacerbate this barrier dysfunction. Individuals with eczema have an overactive immune response to environmental triggers. In winter, increased exposure to indoor allergens, such as dust mites and pet dander, can further stimulate this immune response, leading to inflammation and itchiness. 2
TREATMENT STRATEGIES
Effective management of eczema, particularly in winter, requires a multifaceted approach.
1. Emollients and moisturisers
The cornerstone of eczema management is the regular use of emollients and moisturisers to restore the skin barrier and retain moisture. 2
• Frequency: Advise patients to apply emollients at least twice daily and immediately after bathing
• Types: Recommend thick creams or ointments rather than lotions, as they provide a better barrier against moisture loss
• Ingredients: Look for products containing ceramides, glycerin, or urea, which are beneficial for skin hydration. 2
2. Topical corticosteroids
Topical corticosteroids are the mainstay for managing acute flare-ups by reducing inflammation and itchiness. 2,3
• Strength: The appropriate potency is based on the severity and location of the eczema 2
• Duration: Educate patients on the correct duration of use to prevent potential side effects, such as skin thinning. 2
3. Topical calcineurin inhibitors
For sensitive areas, such as the face and intertriginous zones, where corticosteroids might not be suitable, topical calcineurin inhibitors (eg, tacrolimus, pimecrolimus) can be effective. Advantages include: 2,4
• Less risk: Lower risk of skin thinning compared to corticosteroids2,4
• Long-term use: Suitable for long-term management of eczema. 2
4. Wet wrap therapy
For severe eczema flare-ups, wet wrap therapy can be beneficial. This involves applying emollients and wrapping the affected areas with wet bandages to enhance moisture retention and absorption of topical treatments. 2 By implementing effective management plans and providing continuous support, pharmacists can significantly improve the quality of life for individuals suffering from eczema during the winter months.
*References available on request
20%
Eczema is an inflammatory dry itchy skin condition affecting around 20% of children1
Power of dietary supplements: who needs them and why
Discover how dietary supplements can bridge nutritional gaps, enhance health, and address specific dietary needs
Dietary supplements have gained significant popularity recently. Registered dietitian, Shani Cohen, discusses their importance and who may benefit from them.
WHO SHOULD TAKE SUPPLEMENTS?
Patients who may benefit from dietary supplements, include:
• Those with unbalanced diets
• Individuals with dietary restrictions or intolerances (eg, vegans, lactose intolerance)
• People with nutritional deficiencies
• Athletes undergoing strenuous exercise with limited recovery time
• Pregnant or breastfeeding women
• Some vegetarians and vegans
• People with malabsorption issues
• Individuals consuming excessive alcohol.
IMPORTANCE AND EFFECTIVENESS
Supplements are crucial when treating deficiencies, medical conditions, or supporting health and wellness goals. Their effectiveness varies based on individual circumstances. Despite efforts to maintain a balanced diet, many fail to meet the recommended daily nutrient intake, particularly the 5-9 servings of fruits and vegetables. Supplements can bridge this gap, especially for those with malabsorption issues, gastrointestinal losses, increased nutrient requirements (eg, cancer or surgical patients, pregnant women).
COMMON SUPPLEMENTS
Popular supplements include multivitamins, calcium, and vitamin C. During pregnancy, iron and folic acid are vital, and vitamin D is beneficial
during breastfeeding. Vegans benefit from vitamin B12, only found in animal products. Vitamin C, an antioxidant, is believed to support the immune system and became popular during Covid-19.
RISKS OF SUPPLEMENTS
There is a lack of stringent regulation in supplement manufacturing and marketing, leading to potential safety and efficacy issues. Supplements may contain undisclosed substances, posing health risks like allergic reactions, toxicity from overdosing, and contamination. Toxicity from nutrients is rare through diet alone but possible through supplementation. Furthermore, supplements haven’t been tested in all age groups, including children and pregnant women, necessitating caution.
ADVICE FOR SAFE USE
Pharmacists should advise patients to:
• Maintain a balanced diet from all food groups
• Seek nutrition assessments from registered dietitians
• Understand drug-nutrient interactions
• Consult professionals before taking supplements to ensure correct dosages and safety.
ADDITIONAL CONSIDERATIONS
Many patients fail to meet the recommended daily nutrient intake, particularly the 5-9 servings of fruits and vegetables
There’s a misconception that supplements can offset poor dietary choices and modern lifestyle stresses. Ensuring supplement safety involves investigating manufacturing practices, company history, and product range. Certification verifying ingredient authenticity, amounts, sourcing, and manufacturing practices should be requested, with testing done for each product batch.
SCAN ME
Help your patients beat their worst nasal symptoms
Recommend Otrivin Plus for nasal congestion and rhinorrhea 1
Each 1 ml contains 0,6 mg of ipratropium bromide and 0,5 mg of xylometazoline hydrochloride for symptomatic relief with 1:
• Sinus pressure
• Runny nose
• Blocked nose 3 IN
Reference: 1. OTRIVIN PLUS Nasal Metered-dose Spray (Solution) package insert February 2021.
2 OTRIVIN PLUS Nasal Metered-dose Spray (Solution). Each 1 ml contains 0,6 mg of ipratropium bromide and 0,5 mg of xylometazoline hydrochloride. (Preservative-free). Reg. no.: 46/16.1/0819. Applicant: Haleon South Africa (Pty) Ltd. 11 Hawkins Avenue, Epping Industria 1, Cape Town, 7450 Company reg. no.: 2014/173930/07. For full prescribing information refer to the professional information approved by the
Always read label prior to use. For any further information, including safety and
mystory.za@haleon.com.
Topical nasal decongestion: enhancing quality of life during the common cold
The common cold, an acute and mild upper respiratory condition, is the most frequent human disease. Adults typically experience at least one cold per year, with the frequency varying by age. Caused primarily by rhinoviruses, the common cold is self-limiting, lasting about 7-10 days. Symptoms include nasal congestion, cough, sore throat, sneezing, runny nose, and headaches, often leading to sleep disruption, fatigue, cognitive impairment, and reduced alertness. These symptoms significantly affect quality of life (QoL), impacting daily activities and work performance. Among these symptoms, nasal congestion is particularly troublesome. It peaks around the second and third days of illness and can cause sleep disturbances, leading to daytime somnolence and mood changes. Although no cure exists, treatments like topical decongestants, such as xylometazoline hydrochloride, can alleviate nasal congestion, allowing easier breathing.
IMPACT ON QUALITY OF LIFE
While previous studies have shown that topical decongestants improve QoL in allergic rhinitis, there was no research on their impact during the common cold. This study aimed to evaluate the effects of xylometazoline hydrochloride 0.1% nasal spray on the QoL of individuals with common cold-related nasal congestion.
STUDY DESIGN AND FINDINGS
This real-world, open-label study demonstrated that using xylometazoline hydrochloride significantly improves QoL factors from day one of treatment. The Wisconsin Upper Respiratory Symptom Survey (WURSS-21) scores showed a marked improvement in both symptom severity and QoL from day one, suggesting that nasal decongestion allows individuals to resume daily activities sooner than the natural course of the illness.
SLEEP QUALITY AND VITALITY
Nasal congestion often leads to poor sleep quality, causing fatigue, irritability, and daytime dysfunction. This study found that xylometazoline hydrochloride improved sleep quality and related QoL factors such as ‘sleep well’ and ‘snoring’ from day one. Improved sleep, in turn, enhanced vitality factors like energy, motivation, and alertness.
PHYSICAL ACTIVITY AND SOCIAL INTERACTION
Participants reported an increase in physical activities, such as walking and exercising, from day two of treatment. Improved breathing also positively affected social interactions and reduced feelings of self-consciousness, enhancing overall social engagement and reducing the negative emotional impact of the common cold.
SENSORY PERCEPTION AND NUTRITIONAL INTAKE
Xylometazoline hydrochloride also improved the senses of smell and taste from day one, which likely made eating more enjoyable and ensured better nutritional intake during the cold.
LIMITATIONS AND CONCLUSION
The study's single-arm, open-label design, which allowed for the use of concomitant medications, is a limitation. Nonetheless, the significant improvements in symptoms and QoL suggest that xylometazoline hydrochloride 0.1% effectively alleviates nasal congestion and enhances QoL during the common cold. This real-world evidence provides valuable insights for healthcare providers in managing common cold symptoms, emphasising the importance of symptomatic relief in improving patient QoL.
SOURCE: Hagen M, et al. A real-world study of quality of life following treatment with xylometazoline hydrochloride in individuals with common cold. Ther Adv Respir Dis. 2024 JanDec;18:17534666241228927. doi: 10.1177/17534666241228927. PMID: 38372128; PMCID: PMC10878222.
Caused primarily by rhinoviruses, the common cold is selflimiting, lasting 7-10 days
SCAN ME
Dry skin relief
Moisturising relief for skin prone to psoriasis and eczema.
SOURCE: National Institutes of
Spotlight on psoriasis: preventing patches of itchy, sore skin
Psoriasis is a chronic skin disorder that affects more than 6.7 million US adults. In SA 2.9% of the population is estimated to suffer from psoriasis. Symptoms vary but are usually recognised by itchy or sore patches of thick, red skin with silvery scales. While there's no cure, treatment often helps manage the symptoms.
Psoriasis occurs when skin cells rise to the surface too quickly and build up into thick patches, or plaques. Normally, skin cells mature as they rise from below the surface, but in psoriasis, these cells pile up before maturing properly.
Psoriasis begins in the immune system, which normally protects the body against infection. In psoriasis, the immune system becomes overactive, causing redness, swelling, and the rapid build-up of skin cells. Plaques most often appear on the elbows, knees, or scalp, but they can affect any skin-covered region, including the face, nails, and genitals.
Dr Joel Gelfand, a dermatologist at the University of Pennsylvania, notes, “Patients can have a lot of symptoms like itching, cracking, and bleeding that can disrupt their sleep and social relationships.” People with moderate to severe psoriasis may feel self-conscious, leading to depression or social isolation. Some people with psoriasis also experience joint inflammation, known
2.9% of the SA population is estimated to suffer from psoriasis
as psoriatic arthritis, which produces arthritis-like pain. Psoriasis, especially severe cases, is linked to other disorders such as heart conditions, obesity, high blood pressure, and diabetes.
While it can occur at any age, psoriasis typically first appears in young adulthood. Many people with psoriasis have a family history of the disorder. Researchers have identified certain genes linked to the disease, though the process is not fully understood. Importantly, psoriasis isn't contagious; you can't ‘catch’ it by touching someone who has it.
Psoriasis can be hard to diagnose because it can resemble other skin diseases. As a result, doctor may need to examine a skin sample under a microscope. For an accurate diagnosis, it’s often best to see a primary care doctor or a dermatologist.
There are many treatments for psoriasis, including creams, light therapy, and medications taken orally or by injection.
“Treatment decisions in psoriasis need to be highly individualised and tailored toward the patient’s clinical condition and underlying health status, as well as their preferences and goals,” said Dr Gelfand.
Psoriasis symptoms may briefly worsen or flare. These flares can occur due to stress, traumatic events, smoking, heavy alcohol use, and being overweight. Managing these factors can help in reducing flares and maintaining better control over the condition.
SCAN ME
Health
Psoriasis
SOURCE: Specialist Forum
Adherence key to acne improvement
Acne vulgaris is a common, chronic skin disease that often requires prolonged treatment. Good adherence to medication and adjuvants are associated with higher clinical improvement
Acne vulgaris, primarily appearing on exposed areas like the face and chest, can lead to scarring and significantly affect a patient's life quality. Adherence to prescribed medication greatly influences treatment effectiveness, yet studies reveal low adherence rates, hindering therapy success, especially with combined topical and systemic treatments.
Tailoring treatment plans to individual patient needs, preferences, and expectations is essential.
TYPE OF ACNE
Mild
Moderate
Considering potential adverse effects and providing alternatives to improve tolerability, such as skin barrier repair therapies, can enhance adherence. Additionally, fostering a strong relationship with patients is crucial, offering support and motivation, particularly for chronic conditions impacting self-esteem and quality of life.
Specialist dermatologist, Dr Rakesh Newaj recommends the following treatment for mild to severe acne:
PROPOSED TREATMENTS
Topical treatment with a retinoid cream is effective for comedonal acne. It can be combined with other topical creams like benzoyl peroxide. Other topicals like antibiotics, azelaic acid, topical dapsone or salicylic acids may be effective. Patients can benefit from chemical peels as an add-on treatment.
A combination approach is advised for moderate acne. Patients will benefit from topicals as well as oral treatments. If there are many pustules, an oral antibiotic together with topical retinoids and benzoyl peroxide can help most cases. In females, where a hormonal association is suspected (acne worsening perimenses), the use of cyproterone acetate with topical therapy is advised In patients who are forming scars or are very disturbed by their pimples, the use of oral isotretinoin should be considered early Keratolytic chemical peels will assist most patients.
Severe
Recurrent or nonresponsive to treatment
Severe cases are best referred to dermatologists. However, the use of isotretinoin must be considered as one of the first options. Where there are many cysts and severe inflammation, a short course of low dose steroids can help to prevent scarring. Some cysts need to be drained or injected with steroids.
Patients that cannot tolerate isotretinoin need to be dealt with through the use of alternative therapy, like chemical peels, lasers and photodynamic therapy.
One should reconsider the diagnosis if there is no response to treatment. Several conditions like rosacea, trichoepitheliomas or syringomas can form lesions on the face, that look similar to acne.
One should also ascertain if the patient adhered to treatment or taking certain medications that aggravate acne (steroids, psychiatric medications etc).
Severe stress, poor social habits, obesity (insulin resistance), heavy make-up and over-zealous cleansing/scrubbing of the face do aggravate acne.
Short courses or low-doses of isotretinoin are becoming more popular in the maintenance of acne.
Acne vulgaris, primarily appearing on exposed areas like the face and chest, can lead to scarring and significantly affect a patient's life quality
SCAN ME
CROSSWORD #65
TO ENTER
Use the letters in the highlighted blocks to find the final answer for this month’s crossword puzzle. Email the answer with your name, surname, and cell phone number to PharmacyMagazine@newmedia.co.za. Competition closes 20 August 2024. Winners will be contacted directly. Visit www.pharmacymagazine.co.za for full terms and conditions.
ACROSS
2. Acne vulgaris is a common, chronic skin disease that often requires treatment. (PAGE 25)
6. Wound healing is a complex and dynamic process critical to restoring the of the skin and underlying tissues after injury. (PAGE 15)
11. Probiotics are live , known as ‘good bacteria’, naturally found in the intestines. (PAGE 11)
14. Entiro Probiotic is a range of probiotic supplements that helps the good keep a healthy balance in the gut. (PAGE 10)
15. Caused primarily by , the common cold is self-limiting, lasting 7-10 days. (PAGE 21)
16. Fermented foods like sauerkraut, kimchi, kombucha, and Greek yogurt contain live microorganisms that enhance gut . (PAGE 11)
DOWN
1. E45 gets to work instantly to help dry skin. (PAGE 16)
2. 2.9% of the SA population is estimated to suffer from (PAGE 23)
3. A herbal demulcent, marshmallow root extract is traditionally used for oral or irritation and associated dry cough. (PAGE 13)
4. Influenced by factors, winter can be a particularly challenging season for many patients suffering from eczema. (PAGE 17)
5. Ferrous Forte Somal contains the smallest iron particles with 99% bioavailability and no expected digestive system side effects. (PAGE 5)
7. A study found that in winter 2023-2024, the risk of death in patients for Covid-19 was greater than the risk of death in patients hospitalised for seasonal influenza. (PAGE 4)
8. Nite reduces the urge to cough and helps promote sleep. (PAGE 12)
9. Elastoplast boasts advanced waterproof for up to 2x faster healing. (PAGE 14)
10. Studies have shown that zinc lotions can assist with mild to acne. (PAGE 24)
12. SA has one of the highest rates of childhood asthma in Africa, and are experiencing more severe asthma symptoms than ever before. (PAGE 9)
13. Many patients fail to meet the recommended daily intake. (PAGE 19)
