6.11 & 6.16 Warts and Minor Foot Conditions & Alopecia
Warts and Minor Foot Conditions & Alopecia
Warts
Objectives include understanding the use of different products for alopecia, which is important for pharmacists.
Treatment options for warts:
Salicylic acid: A keratolytic agent.
Comes in liquid form (17%).
Comes as a pad or plaster (40%).
Cryotherapy (freezing options):
Dimethyl ether with propane.
Nitrous oxide.
Warts are caused by HPV (human papillomavirus).
Many different types exist, including genital and cervical warts, but the focus is on non-genital warts on the skin.
More common in children and adolescents, peaking around ages 12-16.
The virus enters via minor injury or abrasion in the skin and replicates.
Risk factors:
Previous warts.
Suppressed immune system.
Going barefoot in wet surfaces (e.g., public swimming pools).
Working in meat handling (HPV can live on the surface of meat).
Biting fingernails, which puts you at risk for periungual warts.
Self-treatable types:
Common warts: Typically on the hands.
Plantar warts: Typically on the feet.
Veruca vulgaris: Latin for common wart.
Common warts:
On the hands.
Often described as having a cauliflower appearance (papule with a rough texture).
Usually painless but can get irritated and bleed if rubbed or caught on something.
Begin as a small papule and enlarge over time, developing the cauliflower appearance.
Incubation period: Up to eight months, depending on the individual's immune response.
Aggravating factors include auto-inoculation (spreading to oneself) through contact.
Patients should wash their hands frequently to prevent auto-inoculation.
Plantar warts:
On the feet.
Tend to be flat due to pressure from walking.
Identified by a disruption in the normal skin ridges.
Can be more painful than common warts due to their location on the foot.
Distinguished from corns or calluses by the presence of black dots, which are localized thromboses (pinpoint bleeding).
Also enlarge with irritation.
Non-self-treatable warts:
Flat warts: Usually on the face.
Mosaic warts: Many plantar warts clustered together.
Periungual warts: Around the nails (cuticle), causing thickening and are hard to treat.
Filiform warts: Finger-like projections.
Referral is needed for periungual warts to a dermatologist, who typically uses cryotherapy.
Flat warts and filiform warts may also need referral.
Mosaic warts are not self-treatable.
Exclusions to self-care:
Patients less than four years old.
Conditions affecting circulation in hands or feet (e.g., diabetes, peripheral vascular disease, neuropathy) due to the risk of tissue damage from debridement.
Self-care options debride the skin, potentially causing serious damage if sensation is impaired.
Multiple warts (greater than 10) in one location or mosaic warts.
Immunosuppressed conditions leading to widespread warts.
Debilitating plantar warts causing difficulty walking, as over-the-counter treatments take too long.
Warts on the face, nails, or genitals.
Immunocompromised patients or those on immunosuppressive therapy.
Immunosuppressed patients:
Examples include those with a history of HIV, patients on chemotherapy, or patients on long-term systemic steroids like prednisone.
Pregnant or breastfeeding patients should consult their doctor before using over-the-counter products.
Debilitating plantar warts that interfere with shoe-wearing may require referral.
Salicylic acid:
A keratolytic agent that breaks down keratin (the "cement" holding skin cells together).
Breaks down skin cells, removing bulk and allowing the immune system to react.
Contraindicated in patients with a severe aspirin allergy (up for debate, but it's best avoided).
Salicylate and NSAID: Aspirin is a salicylate and an NSAID, while ibuprofen is just an NSAID.
Salicylic acid products:
Colloidion (liquid) 17% solution or gel.
Plasters or pads 40%.
Application:
Wash and dry the area before applying.
Applying after a shower may be best when the skin is softer.
Apply one drop at a time, only to the affected area, to avoid destroying healthy skin.
Protect healthy skin by applying a ring of petrolatum around the wart.
Repeat for up to 12 weeks, as it takes a long time for the products to work.
Plasters or pads (40%):
Cut to the size of the wart.
Apply to the wart, ensuring it doesn't contact healthy skin.
Cover with an adhesive (Band-Aid or surgical tape).
Apply and remove every 48 hours for up to 12 weeks.
Avoid recommending old salicylic acid "chapstick" applicators due to the risk of accidental ingestion.
If the patient has a wart on their foot, MediPlast (salicylic acid pads) is the better option because it's a higher percentage.
A referral is needed if a patient has multiple warts, diabetes, or an aspirin allergy.
Cryotherapy:
Destroys tissue and elicits an immune response.
Two over-the-counter options:
Nitrous oxide.
Dimethyl ether with propane.
Nitrous oxide claims to reach lower temperatures, but neither gets as cold as liquid nitrogen used in a doctor's office (negative 196 degrees Celsius).
Over-the-counter options reach approximately negative 20 to negative 57 degrees. Celsius
Application is a bit complicated, and the wart may fall off after 10 days, but repeating after 14 days (up to four times) is often necessary.
Avoid touching healthy skin with the frozen applicator to avoid irritation.
Can cause aching, burning, and general irritation in the area.
More expensive than salicylic acid pads.
Cryotherapy products tend to be more than 10.
Application method:
Aerosolized canister with an applicator (looks like a cigarette filter) that is sprayed and then applied to the skin.
Apply for a shorter period (20 seconds) on common warts and longer (up to 40 seconds) on plantar warts.
The common wart is located on more sensitive skin of the hands.
Combination products: Dual power products contain both salicylic acid and cryotherapy.
Might be more effective but aren't suitable for patients with sensitive skin.
Key counseling points:
Review exclusions to self-care.
Don't use on irritated, red, or infected skin (refer instead).
Apply only to the wart to avoid irritation and pain on healthy skin.
It may take a week or two to see improvement and up to three months for the product to work.
The success rate with over-the-counter products is low (40-50%).
Inform patients that it takes a long time to be patient with treatments.
Apply after a shower or soaking the area to help the medication penetrate further, but ensure the skin is dry when applying the product and Band-Aid.
Duct tape:
Traditional, silver, thicker duct tape can be used for warts.
Cut to the size of the wart, cover it, and put a Band-Aid over it.
Leave on for six to seven days, then debride the area with an emery board (nail file).
Repeat this process two more times or up to two months.
It is economical and viable.
Doctors sometimes prescribe duct tape for warts.
Non-pharmacological recommendations:
Wash hands frequently, especially after touching the wart, to prevent auto-inoculation.
Dry hands thoroughly after washing, as moist skin can facilitate the entry of the wart virus.
Use a specific towel (or paper towels) to dry the area.
Keep the area covered with a Band-Aid to prevent spreading it to others.
Avoid picking at or biting the wart to prevent the spread of the virus.
If it's on the feet, avoid walking barefoot and keep it covered at the gym or in public places.
Minor Foot Disorders
Include calluses, corns, and bunions.
Calluses form on feet from standing for long periods.
Calluses and corns are caused by friction, whereas warts are caused by a virus.
Corns:
Form an apex.
Sharply demarcated hyperkeratotic lesion with a central core.
Occur on bony areas or joints, such as the little toe.
Flesh-colored or grayish.
Point inwards and can be uncomfortable.
Caused by tight-fitting shoes.
Medical term: Clavus
Calluses:
Occur on the big toe or from rubbing against something.
Can occur on fingers from writing.
Ingrown toenails:
The edge of the toenail catches and forms underneath the skin.
Can be hereditary or from pointy shoes or incorrect nail-cutting.
Can also be caused by pressure from bedsheets.
Very painful.
Exclusions to self-care:
Inappropriate gait or malformations of the foot.
Diabetes or peripheral circulatory diseases due to the risk of infection.
Pus or oozing discharge, which indicates an infection.
Pregnancy or breastfeeding since salicylic acid is usually contraindicated.
Non-pharmacological treatments for corns and calluses:
Soaking feet in warm water and filing off dead skin cells with a file or pumice stone.
Avoid using razors or knives to prevent infections.
Wear proper-fitting shoes.
Non-pharmacological recommendations:
Use padding to relieve pressure on corns or calluses.
Use lamb's wool or moleskin as a protectant.
Pharmacological treatment options:
Salicylic acid (40% is recommended for feet).
Sloughs off extra skin cells.
Ingrown toenails:
Soften in warm water, insert cotton underneath the nail to pull it out.
Use sodium sulfide gel (Ingrown Toenail Pain Reliever) to soften the nail and harden the skin.
Benzocaine products and oral analgesics for pain relief.
Refer if there are signs of infection.
Bunions:
The bone protrudes.
Use padding, lamb's wool, or moleskin to make it more comfortable.
Avoid using salicylic acid because it is for skin tissue, not bone.
Alopecia
Alopecia is hair loss and the treatment is minoxidil (Rogaine).
Finasteride is available by prescription for men.
Hormonal changes can cause hair loss, such as postpartum, PCOS, and menopause.
Physiological stress, autoimmune diseases, and certain medications such as chemo can cause hair loss.
Diet changes such as cutting protein caue hair loss.
Compulsive hair plucking
Hair practices can cause hair loss.
Types of hair loss:
Androgenic alopecia:
Gradual onset with a specific progression.
In women, the part in the middle of the scalp becomes thinner, and there is diffuse thinning of the hair.
In men, it starts with a bald spot on the back of the head or receding frontal hairline.
Hereditary
Alopecia areata:
Autoimmune disease that has an abrupt onset.
Can wax and wane and become patchy.
Androgenic is the only one that can be treated with over-the-counter options.
Dihydrotestosterone (DHT) is what causes the hair loss.
Testosterone is converted to DHT by 5-alpha reductase.
Finasteride blocks 5-alpha reductase to reduce hair loss.
Medication blocks by prescription.
Exclusions to self-care:
Patients less than 18 years old because the cause may be medical.
Endocrine disorder such as thyroid conditions.
Chemotherapy.
Sudden or patchy hair loss (alopecia areata).
Pregnancy and breastfeeding.
Topical minoxidil:
Originally approved for hypertension.
A nitrate and vasodilator that increases cutaneous flow and promotes vascularization of hair follicles. (Nitrate = NOX).
Lowers blood pressure.
Comes in 2% or 5% solution and 5% foam.
The 2% solution can be used in men and women.
The 5% solution is technically only approved for men.
The 5% foam is approved for men and women.
Men use 5% foam twice a day, and women use it once a day.
Patient counseling is important:
Hair loss may occur in the first week.
It gets worse before it gets better.
It will take several months before hair growth is seen.
Use it indefinitely to maintain new growth.
Hair density returns to pre-treatment levels in months after discontinuing.
Side effects:
Local irritation.
Hypertrichosis on the forehead and cheeks.
Apply to a clean, dry scalp.
Rub into the affected area and wash hands after application.
Allow two to four hours for the drug to penetrate.
Apply the nighttime dose two to four hours before bedtime.
Use a hair dryer on a low setting to speed up dry time and other hair-styling products after the minoxidil has dried.
The foam is more like a moussey consistency and will melt on contact with warm skin.
Wash hands in cold water, dry hands and apply.
Part the hair and apply more directly to the scalp.
Let it dry, men use it twice a day, and women use it once a day.
Non-pharmacological options:
Camouflage such as hair fibers or hair crayons.
Surgery option.
Avoid hairstyles that pull on the hair.
Avoid heat from hair dryers & Chemical processing.
Brush or comb the hair when it is dry.
Laser hair therapy.
Doesn't know how they work.
Prescription medication only:
Finasteride: Blocks the conversion of testosterone to DHT.
Taken orally once a day.
Used for at least three months to see the benefit was
Originally prescribed for BPH (Benign prostatic hyperplasia)
Can cause orthostatic hypotension, decreased libido, and potentially impotence.
Highly teratogenic.
Women, of childbearing age, are not allowed to count finasteride because if the tablets are broken and you touch it, it can actually cause teratogenicity just by touching a broken tablet.
Brand name: Propecia, Proscar
It also can be used off-label for female pattern hair loss.
Minoxidil (Rogaine) probably might help grow a beard.
Fungal Infections
Dermatophyte: Specific type of fungal infection that likes to live in the keratin.
Fungal skin infections prefer to grow in moisture.
Fungal skin infections usually happen where moisture accumulates, such as feet, scalp, groin, underarms.
Signs of fungal infections:
Soggy, bad odor.
Thickened skin, and thin skin.
Contact dermatitis:
Start with a papule or a wheel.
Vesicles.
Contact Derm vs Fungal:
Both have itching and pain, but you treat fungal infections with an antifungal.
Warm, humid environments.
Patients with diabetes are predisposed to fungal infections because fungus likes to eat sugar carbs, diabetes urinate sugar, and diabetes have immunosupression.
Impaired circulation can be a predisposing factor, occluding the skin at all, and poor nutrition.
Tinea infections are caused by dermatophytes.
Tinea pedis (Athlete's foot)
Symptoms: Itching, stinging, and burning.
Presentation can vary.
More common in Adults and males.
Use public Pools or showers.
High-impact sports.
Predisposing factors:
Wearing Socks and shoes as opposed to sandals is also a predisposing factor.
Fissures can appear.
Ulcerations can appear.
The next one is Tinea Corporus (Ringworm of the body)
It is not a worm, but a fungus.
Itchy circular rash with outer border and red outer border where the fungus is living.
Clearing in central area.
Spreads in daycare centers and contact sports contact skin to skin.
Tenacious microbe.
Can live in the mats of a gym.
Spread by pets.
Predisposing factors:
Cause Skin infections Overweight and obesity,Stress,Skin folds."""
arithmetous means Red
Small circle that's red and then spreads outwards
Spreads from Sentra out to the exposure that's what what it means for the exposures related to the exposure related to the exposure
Tinea crubus, also known as jock itch.
upper thigh scrotal area usually mostly in men.
Distinct border
grows outwards from the center
tends to be bilateral in the upper thigh and pubic area.
Not on the genitals
Tinea tapitis:Ringworm from the scalp
Tinea unguium: Onychomycosis, which is a fungal nail infection.
The only conditions that are candiates for self care:
Tinea Pedis
Tinea Corporis
Tinea Cruris
Tinea infection if there is the
Nail involves the nails are involved and you can refer them on we really don't have anything that we can use treat them with over-the-counter if it's on the face the mucous membranes or genitalia and so with this again we know that tiña the and William I'm sorry tiña crew risk
ends up on the scrotal area but if it's on the penis then we would refer that on if there are signs of secondary bacterial infection if you was or purulent discharge we would refer them if it was more than 5% body surface area or debilitating at all we would refer them if the patient had systemic symptoms like fever or Field malaise then we would refer and patients with diabetes often requires a more extensive therapy
non farm treatment we would end up referring if a patient failed their first treatment we would want to make sure that they were using the product correctly and if they were and it didn't work then we would refer them on for something a little bit more aggressive by prescription so that is this patient a can with I'm so then is here just the same patient has probably what looks like Athletes Foot going on
then they also have nail fungus here so and we do not do not 1115 case same class right to film
*Clotrimazole: Lotrimin AF or if they are going to and then myconazole which is mikatin
*turbinafene: LamacilAT for tinea pedis its 1 week ( between the toes( or 2 week ( bottom or sides))
butenaphene: Lotrimin Ultra for interdigital tinea pedis its unique that is this once it is once and two weeks. i
*Tolnaftate:Tenactin: treatment and and prevention this ones twice a day twice a four
*undesaliienric acid: fungi nail used not recommended ( misleading nail fungus can have have and just don't recomment them.
Here is some generalized information, but I am not able to tailor recommendations to specific patient cases. For warts, the treatment options include salicylic acid and cryotherapy. Salicylic acid is a keratolytic agent that breaks down keratin and is available in liquid form (17%) or as pads/plasters (40%). Cryotherapy involves freezing the wart using dimethyl ether with propane or nitrous oxide. For minor foot disorders like calluses and corns, non-pharmacological treatments include soaking feet in warm water and filing off dead skin. Salicylic acid (40%) can also be used. For ingrown toenails, soften the nail in warm water, insert cotton underneath, and use sodium sulfide gel. For alopecia, topical minoxidil (2% or 5%) is available over-the-counter. Finasteride is a prescription medication that blocks the conversion of testosterone to DHT. Please consult with a healthcare provider for patient-specific advice.
Here is some generalized information, but I am not able to tailor recommendations to specific patient cases. For warts, the treatment options include salicylic acid and cryotherapy. Salicylic acid is a keratolytic agent that breaks down keratin and is available in liquid form (17%) or as pads/plasters (40%). Cryotherapy involves freezing the wart using dimethyl ether with propane or nitrous oxide. For minor foot disorders like calluses and corns, non-pharmacological treatments include soaking feet in warm water and filing off dead skin. Salicylic acid (40%) can also be used. For ingrown toenails, soften the nail in warm water, insert cotton underneath, and use sodium sulfide gel. For alopecia, topical minoxidil (2% or 5%) is available over-the-counter. Finasteride is a prescription medication that blocks the conversion of testosterone to DHT. Please consult with a healthcare provider for patient-specific advice.
For warts, the treatment options include salicylic acid and cryotherapy. Salicylic acid is a keratolytic agent that breaks down keratin and is available in liquid form (17%) or as pads/plasters (40%).
For minor foot disorders like calluses and corns, non-pharmacological treatments include soaking feet in warm water and filing off dead skin. Salicylic acid (40%) can also be used. For ingrown toenails, soften the nail in warm water, insert cotton underneath, and use sodium sulfide gel.
For alopecia, topical minoxidil (2% or 5%) is available over-the-counter. Finasteride is a prescription medication that blocks the conversion of testosterone to DHT.
To prevent spreading warts, wash hands frequently, dry hands thoroughly after washing, use a specific towel to dry the area, keep the area covered with a Band-Aid, avoid picking or biting the wart, and avoid walking barefoot in public places if the wart is on the foot. To minimize discomfort associated with minor foot disorders, soak feet in warm water, file off dead skin cells, avoid using razors or knives, wear proper-fitting shoes, and use padding to relieve pressure on corns or calluses. Lamb's wool or moleskin can be used as a protectant.
Non-pharmacological options:
Camouflage such as hair fibers or hair crayons.
Surgery option.
Avoid hairstyles that pull on the hair.
Avoid heat from hair dryers & Chemical processing.
Brush or comb the hair when it is dry.
Laser hair therapy.
Key counseling points:
Review exclusions to self-care.
Don't use on irritated, red, or infected skin (refer instead).
Apply only to the wart to avoid irritation and pain on healthy skin.
It may take a week or two to see improvement and up to three months for the product to work.
The success rate with over-the-counter products is low (40-50%).
Inform patients that it takes a long time to be patient with treatments.
Apply after a shower or soaking the area to help the medication penetrate further, but ensure the skin is dry when applying the product and Band-Aid.
Ingrown toenails:
Soften in warm water, insert cotton underneath the nail to pull it out.
Use sodium sulfide gel (Ingrown Toenail Pain Reliever) to soften the nail and harden the skin.
Benzocaine products and oral analgesics for pain relief.
Refer if there are signs of infection.
Patient counseling is important:
Hair loss may occur in the first week.
It gets worse before it gets better.
It will take several months before hair growth is seen.
Use it indefinitely to maintain new growth.
Hair density returns to pre-treatment levels in months after discontinuing.
Salicylic acid application:
Wash and dry the area before applying.
Applying after a shower may be best when the skin is softer.
Apply one drop at a time, only to the affected area, to avoid destroying healthy skin.
Protect healthy skin by applying a ring of petrolatum around the wart.
Repeat for up to 12 weeks, as it takes a long time for the products to work.
Plasters or pads (40%):
Cut to the size of the wart.
Apply to the wart, ensuring it doesn't contact healthy skin.
Cover with an adhesive (Band-Aid or surgical tape).
Apply and remove every 48 hours for up to 12 weeks.
Cryotherapy application:
Aerosolized canister with an applicator (looks like a cigarette filter) that is sprayed and then applied to the skin.
Apply for a shorter period (20 seconds) on common warts and longer (up to 40 seconds) on plantar warts.
The common wart is located on more sensitive skin of the hands.
Apply topical minoxidil to a clean, dry scalp. Rub the solution or foam into the affected area, then wash your hands after application. Allow two to four hours for the drug to penetrate, and apply the nighttime dose two to four hours before bedtime. A hair dryer on a low setting can be used to speed up the dry time, and other hair-styling products can be used after the minoxidil has dried. For the foam, wash and dry hands in cold water, then apply it directly to the scalp, parting the hair to ensure the foam reaches the scalp. Let it dry
A hair dryer on a low setting can be used to speed up the dry time, and other hair-styling products can be used after the minoxidil has dried.
Men use the 5% minoxidil foam twice a day. Women use the 5% foam once a day. The 2% solution can be used by both men and women. It is important that men apply the foam twice a day and women apply it once a day to achieve the best results. Also, men and women should apply it to a clean, dry scalp, and rub the solution/foam into the affected area. Then, wash hands after application. Allow two to four hours for the drug to penetrate, and apply the nighttime dose two to four hours before bedtime. A hair dryer on a low setting can be used to speed up the dry time, and other hair-styling products can be used after the minoxidil has dried. For the foam, wash and dry hands in cold water, then apply it directly to the scalp, parting the hair to ensure the foam reaches the scalp. Let it dry. Patient counseling is important - hair loss may occur in the first week and it gets worse before it gets better. It will take several months before hair growth is seen, and it must be used indefinitely to maintain new growth. Hair density returns to pre-treatment levels in months after discontinuing. Side effects: Local irritation and hypertrichosis on the forehead and cheeks may occur. If either of these side effects occur, consult with a healthcare provider on what to do next. It should not be used by patients less than 18 years old, pregnant or breastfeeding. Any endocrine disorder such as thyroid conditions and patients undergoing chemotherapy are also excluded to self-care using topical minoxidil. Patients experiencing sudden or patchy hair loss should also not use the product and seek medical advice. Topical minoxidil includes a nitrate a and vasodilator that increases cutaneous flow and promotes vascularization of hair follicles. (Nitrate = NOX) and lowers blood pressure which is why the counseling points are important. Note that hair practices can cause hair loss along with other causes such as Diet changes such as cutting protein, compulsive hair plucking, physiological stress, autoimmune diseases, and certain medications such as chemo, hormonal changes such as postpartum, PCOS, and menopause. There are different types of hair loss such as androgenic alopecia (only one treatable with OTC options) and alopecia areata. Alopecia areata is an autoimmune disease that has an abrupt onset, can wax and wane, and become patchy. Androgenic alopecia is gradual with a specific progression, and hereditary. Men starts with bald spot on back of head or receding frontal hairline, while women, it is a thin part in the middle of the scalp and diffuse thinning of the hair. Dihydrotestosterone (DHT) is what causes the hair loss. Testosterone is converted to DHT by 5-alpha reductase. Finasteride blocks 5-alpha reductase to reduce hair loss, but it is a prescription medication only. Non-pharmacological options to treat hair loss include camouflage such as hair fibers and hair crayons, and surgery. It is also important to avoid hairstyles that pull on the hair, heat from hair dryers/chemical processing, and brush or comb the hair when it is dry. Laser hair therapy is also an option but how it works is unknown. Finasteride can also be used taken orally once a day and is also used for BPH Benign prostatic hyperplasia. Note some side effects may include orthostatic hypotension, decreased libido, and potentially impotence. Women
Medication options for warts include salicylic acid and cryotherapy. Salicylic acid is a keratolytic agent that breaks down keratin and is available in liquid form (17%) or as pads/plasters (40%). It is applied directly to the wart after washing and drying the area, with care taken to protect healthy skin. It can be used for common and plantar warts. Cryotherapy involves freezing the wart using dimethyl ether with propane or nitrous oxide. It is applied using an aerosolized canister with an applicator, with shorter application times for common warts (20 seconds) and longer times for plantar warts (up to 40 seconds). It can also be used for common and plantar warts. Combination products containing both salicylic acid and cryotherapy might be more effective but aren't suitable for patients with sensitive skin.
For minor foot disorders like calluses and corns, non-pharmacological treatments include soaking feet in warm water and filing off dead skin. Salicylic acid (
40%) can also be used.
For ingrown toenails
of testosterone to DHT.
To prevent spreading warts, wash hands frequently, dry hands thoroughly after washing, use a specific towel to dry the area, keep the area covered with a Band-Aid, avoid picking or biting the wart, and avoid walking barefoot in public places if the wart is on the foot. To minimize discomfort associated with minor foot disorders, soak feet in warm water, file off dead skin cells, avoid using razors or knives, wear proper-fitting shoes, and use padding to relieve pressure on corns or calluses. Lamb's wool or moleskin can be used as a protectant.
Non-pharmacological options:
- Camouflage such as hair fibers or hair crayons.
- Surgery option.
- Avoid hairstyles that pull on the hair.
- Avoid heat from hair dryers & Chemical processing.
- Brush or comb the hair when it is dry.
- Laser hair therapy.
- Key counseling points:
- Review exclusions to self-care.
- Don't use on irritated, red, or infected skin (refer instead).
- Apply only to the wart to avoid irritation and pain on healthy skin.
- It may take a week or two to see improvement and up to three months for the product to work.
- The success rate with over-the-counter products is low (40-50%).
- Inform patients that it takes a long time to be patient with treatments.
- Apply after a shower or soaking the area to help the medication penetrate further, but ensure the skin is dry when applying the product and Band-Aid.
- Ingrown toenails:
- Soften in warm water, insert cotton underneath the nail to pull it out.
- Use sodium sulfide gel (Ingrown Toenail Pain Reliever) to soften the nail and harden the skin.
- Benzocaine products and oral analgesics for pain relief.
- Refer if there are signs of infection.
- Patient counseling is important:
- Hair loss may occur in the first week.
- It gets worse before it gets better.
- It will take several months before hair growth is seen.
- Use it indefinitely to maintain new growth.
- Hair density returns to pre-treatment levels in months after discontinuing.
Salicylic acid application:
Wash and dry the area before applying.
Applying after a shower may be best when the skin is softer.
Apply one drop at a time, only to the affected area, to avoid destroying healthy skin.
Protect healthy skin by applying a ring of petrolatum around the wart.
Repeat for up to 12 weeks, as it takes a long time for the products to work.
Plasters or pads (40%):
Cut to the size of the wart.
Apply to the wart, ensuring it doesn't contact healthy skin.
Cover with an adhesive (Band-Aid or surgical tape).
Apply and remove every 48 hours for up to 12 weeks.
Cryotherapy application:
Aerosolized canister with an applicator (looks like a cigarette filter) that is sprayed and then applied to the skin.
Apply for a shorter period (20 seconds) on common warts and longer (up to 40 seconds) on plantar warts.
The common wart is located on more sensitive skin of the hands.
Apply topical minoxidil to a clean, dry scalp. Rub the solution or foam into the affected area, then wash your hands after application. Allow two to four hours for the drug to penetrate, and apply the nighttime dose two to four hours before bedtime. A hair dryer on a low setting can be used to speed up the dry time, and other hair-styling products can be used after the minoxidil has dried. For the foam, wash and dry hands in cold water, then apply it directly to the scalp, parting the hair to ensure the foam reaches the scalp. Let it dry
A hair dryer on a low setting can be used to speed up the dry time, and other hair-styling products can be used after the minoxidil has dried.
Men use the 5% minoxidil foam twice a day. Women use the 5% foam once a day. The 2% solution can be used by both men and women. It is important that men apply the foam twice a day and women apply it once a day to achieve the best results. Also, men and women should apply it to a clean, dry scalp, and rub the solution/foam into the affected area. Then, wash hands after application. Allow two to four hours for the drug to penetrate, and apply the nighttime dose two to four hours before bedtime. A hair dryer on a low setting can be used to speed up the dry time, and other hair-styling products can be used after the minoxidil has dried. For the foam, wash and dry hands in cold water, then apply it directly to the scalp, parting the hair to ensure the foam reaches the scalp. Let it dry. Patient counseling is important - hair loss may occur in the first week and it gets worse before it gets better. It will take several months before hair growth is seen, and it must be used indefinitely to maintain new growth. Hair density returns to pre-treatment levels in months after discontinuing. Side effects: Local irritation and hypertrichosis on the forehead and cheeks may occur. If either of these side effects occur, consult with a healthcare provider on what to do next. It should not be used by patients less than 18 years old, pregnant or breastfeeding. Any endocrine disorder such as thyroid conditions and patients undergoing chemotherapy are also excluded to self-care using topical minoxidil. Patients experiencing sudden or patchy hair loss should also not use the product and seek medical advice. Topical minoxidil includes a nitrate a and vasodilator that increases cutaneous flow and promotes vascularization of hair follicles. (Nitrate = NOX) and lowers blood pressure which is why the counseling points are important. Note that hair practices can cause hair loss along with other causes such as Diet changes such as cutting protein, compulsive hair plucking, physiological stress, autoimmune diseases, and certain medications such as chemo, hormonal changes such as postpartum, PCOS, and menopause. There are different types of hair loss such as androgenic alopecia (only one treatable with OTC options) and alopecia areata. Alopecia areata is an autoimmune disease that has an abrupt onset, can wax and wane, and become patchy. Androgenic alopecia is gradual with a specific progression, and hereditary. Men starts with bald spot on back of head or receding frontal hairline, while women, it is a thin part in the middle of the scalp and diffuse thinning of the hair. Dihydrotestosterone (DHT) is what causes the hair loss. Testosterone is converted to DHT by 5-alpha reductase. Finasteride blocks 5-alpha reductase to reduce hair loss, but it is a prescription medication only. Non-pharmacological options to treat hair loss include camouflage such as hair fibers and hair crayons, and surgery. It is also important to avoid hairstyles that pull on the hair, heat from hair dryers/chemical processing, and brush or comb the hair when it is dry. Laser hair therapy is also an option but how it works is unknown. Finasteride can also be used taken orally once a day and is also used for BPH Benign prostatic hyperplasia. Note some side effects may include orthostatic hypotension, decreased libido, and potentially impotence. Women