As the UK experiences various stages of lockdown, and restrictions of many kinds are put on daily life, pharmacy customers will be holidaying at home this year or, if they are able to in the coming months, travelling a little further afield than their front doorstep or garden. With a strong focus on hygiene and the prevention and management of Covid-19, it could be very easy for general summer health to be overlooked. Yet self care is particularly important at the present time, with primary and secondary healthcare services so overstretched and a pressing need for people to keep their immune systems in good working order.
As the weather changes, certain seasonal health concerns may need to be addressed, including injuries, allergies, skincare and first aid. A local pharmacy is likely to be the first port of call for products and advice, so the pharmacy team needs to be prepared for all eventualities.
Hayfever season is now under way, and symptoms can occur even if customers are staying behind closed doors. Some people may be spending more time in their gardens if they are unable to go to work, which means they could be exposed to more pollen than usual or for a longer period of time.
It is important that customers are able to recognise the difference between Covid-19 and hayfever symptoms. Hayfever tends to cause a runny or blocked nose, cough, sneezing and itchy eyes. Allergy UK stresses that hayfever does not cause a high temperature and most sufferers do not feel generally unwell.
In some people, hayfever does trigger allergic asthma, causing a tight chest and difficulty breathing. Asthma UK states on its website: “If your asthma is getting worse and you don’t have symptoms of Covid-19, make an urgent appointment to see your GP as usual. They may ask to speak to you by phone or video. If you have an asthma attack, follow the steps on your action plan and call 999 for an ambulance if you need to.”
According to Allergy UK, it is important that hayfever sufferers make sure they have all of their usual essential medicines – without stockpiling – including antihistamines, eye drops and nasal sprays, and keep using these throughout the hayfever season. If customers also suffer from asthma, they should make sure they have their inhalers and use these as directed by their doctor or asthma nurse.
If customers are planning outdoor activities, they should time these around peak pollen times, avoiding early morning and early evening when pollen counts are at their highest by checking the local weather forecast. Applying petroleum jelly or an allergen barrier balm around the nostrils and eye sockets in the morning and throughout the day should help to stop pollen getting into the body. “Less pollen, less sneezing,” says airborne allergens expert Max Wiseberg. “Wash your face as soon as you get indoors on high pollen count days. This will wash away allergens so that they can’t cause a reaction, and a cool compress will soothe sore eyes.”
To prevent coronavirus transmission, the Government is stressing that everyone should be washing their hands regularly with soap and water or using hand sanitiser gel if handwashing facilities are not available. According to Dr Anjali Mahto, consultant dermatologist and British Skin Foundation spokesperson, the repeated use of soaps, detergents and alcohol gel are a common and important cause of irritant contact dermatitis. It is therefore not surprising that many people are currently developing very dry, sore, itchy and cracked skin on their hands. A rich, non-fragranced moisturiser or hand cream can help to replenish the skin’s natural moisture levels – this should be used straight after washing.
People who are prone to eczema or allergic skin conditions may be at a high risk of a flare up during hot and dry weather. “The main symptom is itching, which can make the eczema worse, disturb sleep and possibly cause a skin infection,” says registered nurse Abigail Morakinyo. “Current treatment involves creams applied to the skin. This can be quite soothing and can alleviate the itchiness, reducing the likelihood of infection.”
Some customers may react to a change in diet if they can’t buy all of their usual food items. If customers are planning to barbecue in their garden, they should follow strict hygiene rules and wash their hands thoroughly before eating or handling food.
Diarrhoea will usually ease without any specific treatment. It is important to drink plenty of fluids – water, squash or diluted fruit juice – taking small sips if they also feel sick. Oral rehydration sachets can be used to replace lost fluids and salts, especially in babies, children and older people. Anti-diarrhoeal medicines are not usually recommended, but can be used to stop diarrhoea for a few hours if necessary. There is some clinical research showing that prebiotics and probiotics may help to treat and prevent diarrhoea.
Indigestion (dyspepsia) can cause heartburn – a burning feeling in the throat caused by acid reflux – as well as a bloated feeling, nausea and excessive wind. It may be triggered by eating too many rich, spicy or fatty foods or drinking too much alcohol, and stress may also make it worse. Customers can usually ease the symptoms themselves by changing their eating habits and lifestyle. Otherwise, they may benefit from over-the-counter medicines, such as antacids, alginates and proton pump inhibitors (PPIs).
Constipation may be triggered by a change in diet, especially one that is low in natural fibre (fruit, vegetables and cereals) or not drinking enough fluids. Simple lifestyle changes can usually help, including eating more fibre-rich foods, being more physically active, drinking plenty of fluids and avoiding alcohol. If diet and lifestyle changes don’t help, a laxative can be used as a short-term measure.
With people staying at home more than usual over the next few weeks and months, it is important that they remain as active as possible to keep their circulation moving. If customers are exercising, they should take precautions to avoid injuries, such as wearing well-fitting supportive trainers and warming up first.
“A walk of just 10 minutes reduces stress, improves mental health and boosts the immune system,” says Dr William Bird MBE, GP and founder of Intelligent Health, which delivers the ‘Beat the Street’ physical activity initiative. “Alternatively, try doing some activities in the home. Perhaps you could climb the stairs if you have some, or you could try chair yoga.”
Dr Bird recommends the following exercise, which is suitable for anyone, including those with mobility problems, for leg strength and circulation:
Bhavin Shah, behavioural optometrist and director of Central Vision in Finchley, London, says that despite requirements to stay indoors, parents should still try to limit their children’s screen time and encourage them to keep active. “Continuous close focus, screens and reading increase the risk of myopia,” he says. “Children need to spend at least two hours outdoors every day for their eye health. Sunlight seems to have a protective effect against myopia, reducing its risk and progression.”
On 23 March 2020, the British Society for Surgery of the Hand issued a warning to the public, asking them to take extra care when doing gardening and DIY, especially if operating power tools. Injuries that need treatment could place extra pressure on the NHS.
For any mishaps, customers should keep a small first aid kit at home with essential supplies, including:
Insect bites and stings can cause itching and discomfort around a red lump on the skin. To reduce the risk of getting bitten or stung, customers should cover all exposed skin, especially in the evenings when outdoors, and use an insect repellent.
If bites or stings do occur, these should be washed with soap and water and covered with a cold compress or ice pack wrapped in a towel to reduce any swelling. Customers can use a topical bite and sting relief product, such as a cream or gel, to ease any pain. If possible, they should raise the affected area, as this can help to reduce swelling, and avoid scratching the skin to reduce the risk of infections.
Some people may have a mild allergic reaction to insect bites and stings, causing redness and swelling around the site. This can be treated with oral antihistamines. If any severe reaction occurs, such as breathing difficulties, a swollen face/mouth or dizziness, customers should seek medical advice straightaway.
Customers who plan to enjoy the sunshine as much as possible need to take good care of their skin, protecting it from sunburn and the increased risk of skin cancer, even in the UK. “Sun exposure can be beneficial to the human body, helping it create vitamin D,” says Dr Jonas Nilsen, MD and co-founder of travel vaccination specialist Practio. “However it can also be harmful. Pharmacy customers should therefore make sure that they have sunscreen with the right SPF to protect their skin from any sun damage.”
If people are spending more time indoors, this could mean they have less exposure to sunshine, but it is still important that pharmacy customers take precautions on the occasions they do venture outside. According to Cancer Research UK, customers can protect their skin, particularly if they are prone to sunburn, by:
Abigail suggests customers apply sunscreen 15 to 30 minutes before going out in the sun to allow it to dry. “Re-apply sunscreen at least every two hours,” she says, “and immediately after the coverage may have reduced due to perspiring or being rubbed off with a towel. A moisturiser with an SPF is not recommended for long periods of sun exposure, for example, sitting in the garden to have lunch.”
If customers experience sunburn, they should cool their skin with a damp towel, running water or after-sun products. If the burn is blistering or they feel very unwell, they should seek medical advice.
There have been concerns that using sunscreen could reduce the skin’s production of vitamin D. However, a King’s College London study in May 2019, published in the British Journal of Dermatology, revealed that using a broad-spectrum sunscreen with SPF15 does not affect most people’s vitamin D levels. This was supported by a systematic review of 75 papers on sunscreen and vitamin D conducted in Australia and published last year in the same journal.
“The risk of vitamin D deficiency from sunscreen has been found to be low, and therefore is unlikely to outweigh the benefits of sunscreen for skin cancer prevention,” says Holly Barber of the British Association of Dermatologists. “Further research is required on SP30 and higher sunscreen, as this is what we recommend people use for optimal protection in real-life situations. People with dark skin types are at a higher risk of vitamin D deficiency, and lower risk of skin cancer, so further research is also required to see how these findings translate to people with dark skin types.”
Romesh Angunawela, eye surgeon and director of Ophthalmic Consultants of London, says that sunglasses are also essential to protect the eyes. “The sun’s UV light can cause a range of eye problems including cataracts, which is a clouding of the eye’s lens that blurs vision and is very common as people get older,” he explains.
Cancer Research UK recommends sunglasses – ideally wraparound so they protect the sides of the eyes – with the CE mark and British Standard and UV400 and 100 per cent UV protection written on the label or sticker.