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Tackling travel health

For many people, this summer will be the first time in three years that they have been able to travel abroad. Here's how pharmacy teams can help remind customers about staying safe under the sun.

After two years of Covid-19 restrictions coming to an end, summer holidays are finally back on the agenda!

Being back in the sun comes with a lot of responsibility for looking after oneself and pharmacy teams can be on hand to give customers the best advice possible.

Sun safety 

Whilst many people view the summer as a chance to relax and sunbathe, sun exposure can cause significant damage to the skin and body. 

The most common and noticeable damage is sunburn; hot and sore skin caused by too much sun exposure. Typically, skin will: 

  • Feel hot to touch
  • Feel sore or painful
  • Flake or peel.

If a customer has white skin, their skin will usually appear red or pink whereas if they have black or brown skin, they may not notice a change of colour. 

“Sunburn is a common complaint in pharmacy and one which most will have experienced in their lives,” says Karen Baker, pharmacist at Care. “It occurs mainly due to individuals underestimating the power of UV rays and adopting a ‘care-free’ attitude whilst relaxing on holiday, resulting in neglecting a safe, sun care routine.”

Sunburn can usually be treated with self care measures such as sponging sore skin with cool water and applying aftersun cream containing aloe vera. Pharmacy staff can also recommend painkillers to reduce inflammation. Customers experiencing sunburn should stay out of the sun until the redness has gone and seek medical help if they feel unwell
or if skin swells and blisters. 

“When we’re talking about sun safety, it really comes down to three things,” says Rachel Orritt, health and information manager at Cancer Research UK. “First, make sure you’re spending time in the shade. If you’re in the shade the sun can’t get to you. Second is covering up with clothing. If you do have to be out in the sun, wear a wide-brimmed hat, sunglasses and t-shirts with long sleeves. Third and finally is sunscreen, use it in combination with shade and clothing and make sure you’re applying it generously and reapplying regularly.”

The pharmacy can stock a variety of sunscreens and staff should be on hand to advise customers which one would suit their needs best. According to the NHS, the best sunscreens have a sun protection factor (SPF) of at least 30 and a 4-star UVA protection rating. 

“Sunscreen typically has a shelf life of six to 12 months, so it’s important for teams to communicate the importance of replacing it every year as the SPF efficacy can drastically reduce over time,” explains Karen. 

The NHS also advises that adults should apply roughly two teaspoons of sunscreen when covering their head, arms and neck and two tablespoons if covering their entire body while wearing a swimming costume. 

The most dangerous time to be out in the sunshine is between 11am and 3pm when the UV rays are strongest, so customers can be advised to stick to the shade during this period or make sure to wear protective clothing. 

If they are planning to be in the sun for extended periods of time, sunscreen should be applied twice. The first time 30 minutes before going out and the second just before. Once outside, it should be reapplied frequently and according to manufacturer instructions. 

“For customers who are concerned about how often to reapply sunscreen, brightly coloured options are available, which provide clarity on when the cream should be reapplied as they act as a clear visual guide to when the sunscreen is no longer present on the skin,” says Sue Swift, Numark UK drug tariff and information technician. “Wrist bands that change colour when more sunscreen is needed can also be purchased from pharmacies for customers who want a more visual reminder of reapplication.”

Sun safety is particularly important for children who – from March to October in UK and abroad – should cover up with suitable clothing, spend most of their time in the shade and wear at least SPF30 sunscreen. Children aged under six months should be kept out of direct sunlight.

Other people who should take extra care in the sun include those who have: 

  • Pale, white or light brown skin
  • Freckles or red/fair hair
  • Many moles
  • Skin problems relating to a medical condition
  • A family history of skin cancer.

Skin cancer

The main danger of sunburn is that it increases a person’s risk of developing skin cancer, the fifth most common cancer in the UK and one of the most prevalent globally. 

According to the NHS, there are around 147,000 new cases of non-melanoma skin cancer diagnosed annually in the UK, alongside 16,000 new cases of melanoma. As darker skin has some protection against UV rays, people with naturally brown or black skin are less likely to get skin cancer but this does not mean the disease cannot still occur. A patient’s chances of developing skin cancer are increased if they have: 

  • A high number of moles or freckles
  • Pale skin that burns easily
  • Red or blonde hair
  • A family history of skin cancer. 

Types of skin cancer

Non-melanoma

Non-melanoma skin cancer often develops on areas of the skin regularly exposed to the sun, such as the face, ears, hands, shoulders, upper chest and back. The first sign is usually a lump or discoloured patch on the skin that slowly progresses over months. 

The cancer usually develops in the outermost layer of the skin. The two most common types of non-melanoma skin cancer are: 

  1. Basal cell carcinoma: this usually appears as a small, shiny pink or pearly white lump, but it can also look like a red, scaly patch. It accounts for about 75 in every 100 skin cancers and does not usually spread to other parts of the body. 
  2. Squamous cell carcinoma: a firm pink lump with a rough or crusted surface, which often feels tender when touched and bleeds easily. There is a small risk (up to five per cent) of it spreading to other parts of the body, usually the lymph nodes. 

Melanoma

Caused by skin cells that develop abnormally, most melanomas are thought to be caused by exposure to UV light via the sun although there is evidence that suggests some may result from sunbed usage. The most common sign is the arrival of a new mole or a change to an existing mole on the body. 

This can happen anywhere, but it is most common on the backs of men and the legs of women and is most uncommon in areas protected from the sun such as the buttocks and the scalp. 

Types of melanomas include: 

  • Superficial spreading melanoma: the most common in the UK, especially in those with pale skin and freckles. Initially tends to grow outwards rather than downwards so doesn’t pose as much of a problem.
  • Nodular melanoma: these are fast to develop and can grow downwards if not removed as soon as possible. They appear as a changing lump on the skin that might bleed and be black or red and are common on the head, neck, chest and back.
  • Lentigo maligna melanoma: these especially affect older people who’ve spent a lot of time outdoors and tend to develop slowly over several years in areas that have been exposed to the sun. They look like a freckle but are usually larger, darker and stand out more than normal.
  • Acral lentiginous melanoma: this usually develops on the palms of hands or sole of feet, sometimes around a nail. This is the most common type of skin cancer in people with dark skin, although it can affect any skin colour. 

“As a pharmacy team we can know the signs and symptoms to look out for and be keen to prompt someone to go to the doctor,” says Rachel. “Knowing things like the ABCDE rule helps us to know when it’s appropriate to know when to refer a patient. So, moles that are/have: Asymmetrical, Irregular Blurred Borders, Uneven Colours, Diameter bigger than end of a pencil or Evolving.” 

A customer should be referred to the pharmacist if they have noticed any changes in their moles.

Sun safety is for life, not just for holidays!

Some customers may not know that sun safety is important even if they are staying in the UK during the summer months. “One of the most important things pharmacy teams can do is help people to understand their risk,” says Rachel.  

“You definitely don’t need to be on holiday to burn so although people may start up these conversations perhaps when they’re going on holiday, that’s not the only time we should be talking about sun safety. 

“You can get burnt in the UK, even when it’s cloudy. If the UV index is three or higher, then that’s when there’s a risk of sunburn so that’s when you should have conversations with people in the pharmacy.” 

The effects of the sun are not the only ailments customers should watch out for on holiday. Travelling to and staying in a new country can bring a whole host of different conditions they may have not had to tackle in the UK. 

Common ailments

Anyone who gets carsick, seasick or airsick suffers from motion sickness. Symptoms include cold sweats, nausea, dizziness and vomiting. The sensation occurs when the brain receives conflicting information from the motion-sensing parts of the body (the eyes, inner ear, muscles and joints) which causes it to not know if a person is stationary or moving. Such confusion provokes feelings of nausea. 

Women and children between the ages of two and 12 are more prone to motion sickness, however it can affect anyone. Customers may be more susceptible to suffering if there is family history; they are on hormonal birth control; they have an inner ear disorder; they are on their menstrual period or are pregnant; they suffer from migraines or Parkinson’s disease.  

Pharmacy teams can advise patients to take some steps to help reduce their risk of suffering. These include:

  • Making sure to sit in the front of the car or in the middle of a boat
  • Looking straight ahead at a fixed point
  • Trying to break up long journeys
  • Breathing in fresh air as much as possible
  • Avoiding reading, using any electronic devices or looking at moving objects such as cars going past. 

If self care tips are not enough, staff can offer patients different treatments. The three main types include: 

  1. Tablets – dissolvable tablets should be made available for small children
  2. Patches – these can be used by anyone over the age of 10
  3. Acupressure bands – although these are sometimes considered to be less effective.

Insect bites and stings from bugs such as wasps, hornets and bees are incredibly common during the summer, whether customers are travelling or not. Most are not serious and usually heal themselves within a day or two, but occasionally can become infected, cause severe allergic reactions or spread serious illnesses. 

To treat the bite or sting, customers should first remove the stinger if still in their skin, then wash the area with soap and water. If there is any swelling, a cold compress or ice pack should be applied for at least 10 minutes and the affected area should be kept elevated. 

Staff should also advise customers to try not to scratch the area to reduce chances of infection and to also avoid using traditional home remedies such as vinegar and bicarbonate of soda. 

Self care precautions could also be recommended such as covering exposed skin at the peak times of sunrise or sunset and making sure to wear shoes outdoors. All customers going abroad should take insect repellent to apply to exposed skin. Repellents that contain 50 per cent DEET are deemed the most effective. 

Aside from repellent, for itching caused by an insect bite or sting, pharmacy teams can recommend crotamiton cream, hydrocortisone cream or an antihistamine tablet.

Make sure to refer a customer if they have been stung or bitten in their mouth, throat or near their eyes. Warning signs needing referral also include:  

  • Symptoms starting to get worse 
  • Symptoms of wound infection (e.g., pus, increasing pain, redness) 
  • Symptoms of widespread infection (e.g., fever or swollen glands)  

This advice should also be given to customers before they travel so that if they are abroad, they know when they have to seek urgent medical advice.  

Staying out in the sun for too long can not only affect your skin but also your body temperature. Heat exhaustion occurs when the temperature of the body rises to anything between 37 degrees Celsius and 40 degrees Celsius. Signs include:  

  • Headache and dizziness 
  • Excessive sweating and clammy skin  
  • Nausea  
  • Cramps in the arms, legs or stomach.  

Symptoms are often the same in adults and children and according to the NHS, the top four things you can do to cool someone down are:  

  1. Move them to a colder place (usually in the shade)  
  2. Get them to lie down and raise their feet slightly 
  3. Get them to drink lots of liquids 
  4. Cool their skin by spraying or sponging them with cold water.  

Pharmacy staff can also recommend that customers take self care measures to prevent heat exhaustion such as:  

  • drinking plenty of cold drinks 
  • wearing light-coloured loose clothing 
  • avoiding extreme exercise 
  • taking cool baths or showers.  

If someone is still feeling unwell after 30 minutes sat in the shade the heat exhaustion may have developed into heat stroke. This means their body cannot cool itself down and they should be referred to the pharmacist.  

For many people, exploring a new place is the best part of their holiday. This usually requires a significant amount of walking which – particularly when done in the wrong footwear – can leave someone more susceptible to developing painful blisters.  

To avoid this, preventative measures can be taken such as:  

  • Wear comfortable, well-fitting shoes 
  • Wear new shoes for short periods of time until comfortable 
  • Wear thick socks during any exercise, including long walks 
  • Dust talcum powder in socks if you get sweaty feet, especially important in hot countries. 

Although blisters often heal on their own within a week, staff can recommend hydrocolloid dressings to protect the skin, help reduce the pain and also speed up the healing process. Advise customers to make sure to take these blister plasters and dressings away with them and follow this self care advice:  

  • Make sure to wash their hands before touching a burst blister 
  • Allow the fluid to drain before covering it with a plaster or dressing 
  • Don’t burst a blister yourself 
  • Do not peel or pick at the skin surrounding the blister  
  • Do not wear shoes or use the equipment that caused the blister until it heals. 

It is also important to make the patient aware that they should not avoid infected blisters as without treatment these could lead to skin or blood infections. Refer a customer to the pharmacist if:  

  • The blister keeps coming back 
  • The skin looks infected; it is hot, and the blister is filled with green or yellow pus 
  • The blister is in an unusual place or has appeared for no reason 
  • The blister was caused by a burn, scald, sunburn or an allergic reaction.  

Know your vaccines

Europe

There are no required vaccinations. However, hepatitis A and B, typhoid, rabies and tickborne encephalitis are recommended. 

Asia

Most countries require some vaccinations to enter, including hepatitis A and B, typhoid, cholera, yellow fever, Japanese encephalitis, rabies, tickborne encephalitis and polio. 

Africa

Most countries require some vaccinations to enter, including hepatitis A and B, typhoid, cholera, yellow fever, meningitis, rabies and polio. 

North America

There are no required vaccinations. However, hepatitis A and B, rabies and tetanus are recommended. 

Central and South America

Most countries require some vaccinations to enter, including hepatitis A and B, typhoid, cholera, yellow fever and rabies.

Oceania

Some countries require some vaccinations to enter, including hepatitis A and B, typhoid, cholera, yellow fever, Japanese encephalitis and rabies. 

Coronavirus control

At the time of writing, there are 148 countries that have travel restrictions due to the Covid-19 pandemic, 46 with no restrictions and 32 with borders closed to non-citizens. 

Travel restrictions usually require all those entering the country to be vaccinated or present a negative PCR test. 

Popular summer holiday destinations without restrictions include Croatia, Cyprus, Egypt, France, Greece, Italy, Mexico, Spain, The Bahamas and Turkey.

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