Scenario

Pharmacy technician Vicky is in the staff room having lunch when counter assistant Mandy pops her head around the door.

“Hi Vicky, I know you’re on a break but could I just pick your brain for a moment?” asks Mandy. “This lady is at the counter and is asking about supplements. She finished treatment for cancer recently, but says her skin and nails are in a bit of a state and wants to take a vitamin supplement. Are those specially designed products worth the money, or do you reckon she’d get as much benefit from one of those all-round, A to Z, type things?”

Answer

This is an interesting question, and one that is tricky to answer because much of the evidence supporting the use of supplements for skin health is either concerned with specific conditions such as eczema or psoriasis, or stems from research funded by cosmetic companies or supplement manufacturers. The British Dietetic Association says that the vitamins and minerals most important to skin health are vitamins A, C and E, riboflavin, niacin, pyridoxine, zinc and selenium, and asserts that following a varied and balanced, healthy diet should be sufficient to give the skin what it needs. This is the best tack for Mandy to take with her customer, though if this is not possible for some reason, a good quality multivitamin and multi-mineral supplement may be the answer.

The bigger picture

Cancer treatments can wreak havoc on the skin, and not in a predictable way. Some people find their skin becomes very dry, whereas others develop rashes and some may find they are more sensitive to sunlight or cosmetic products such as deodorant or perfume than they were previously. A change in skin tone may also occur, with fair skin often reddening slightly, and darker skin tones becoming darker still, sometimes with a blue or black tinge.

For skin that becomes dry, the steps that someone with eczema would follow are a good place to start – for example, using non-perfumed emollients rather than soaps, and regularly applying moisturiser. Having a make-up lesson can help address any issues with changing skin tone, and restore confidence. And using sunscreen when going outside is a must, not just on the face, but on all exposed body parts, such as the hands and neck.

Nails are often affected by chemotherapy as well, so that they grow more slowly, change shape or colour, or, on occasion, are lost altogether. Regularly moisturising the hands can make a difference, taking particular care to rub the product into the nails and cuticles, and wearing gloves when doing chores such as washing up. Toenails can be protected by applying moisturiser and making sure footwear is comfortable. Applying nail polish can disguise discolouration and provide a much-needed confidence boost, but should not be done if nails are split or painful. Application of false nails is not recommended.

Other simple steps that can be beneficial to skin include giving up smoking, drinking plenty of water, taking regular exercise, reducing stress levels and getting good quality sleep.

Extend your learning

• The answer to the scenario lists riboflavin, niacin and pyridoxine among the nutrients that are important for skin health. These are all types of vitamin B, but do you know which ones? Check your understanding at NHS Choices
• This scenario talks about caring for skin after cancer treatment has finished, but radiotherapy, which is commonly used in oncology, can be very damaging to skin, particularly to the entry and exit sites if the treatment is administered externally. Find out more about this at Cancer Research UK
• Nutritional supplement fixtures in pharmacies and other retail outlets are often very confusing for customers. Have a good look at yours and think about whether it could be laid out more logically. Does it need extra shelf edge labelling to make things clearer for the public? Would it benefit from some leaflets or information posters? Make a plan and discuss it with your colleagues and manager
• Refresh your knowledge of sunscreens, which is important to many people all year round and not just during the summer months or when abroad, at: British Association of Dermatologists: Sunscreen Fact Sheet. Do you think you have enough on the shop floor at the moment, or does the section require an overhaul?