Brian Adams

Pharmacy is a key player in skin care. From rosacea to common skin infections and psoriasis, pharmacists are playing a growing role in the successful treatment of dermatological problems.

"There are effective over- the-counter treatments for multiple common skin infections, including athlete's foot and tinea corporis gladiatorum [ringworm]," said Brian Adams, M.D., sports medicine specialist and associate professor of dermatology, University of Cincinnati College of Medicine. For most other skin infections common to athletes, prevention is the key to averting teamwide outbreaks, Adams told attendees of the recent American Academy of Dermatology annual meeting in San Francisco.

Linda F. Stein-Gold

Just keeping feet drier during exercise can cut the incidence of impetigo on the feet, a superficial skin infection typically caused by Staphylococcus aureus or streptococcus. Pitted keratolysis (sweaty sock syndrome), plantar verruca (foot warts), and tinea pedis (athlete's foot) can also be largely prevented by keeping feet drier.

The alternative is topical or oral prescription drug treatment or surgery. In some cases, athletes may be banned from competing or training until the infection is cured.

James Del Rosso

Athletes at all levels are at increased risk for a variety of skin infections, Adams said. Wrestlers and rugby players, for example, have a one-in-three chance of contracting herpes simplex virus through skin-to-skin contact.

Football players, particularly linemen, are susceptible to skin boils. Epidemic infections of methicillin-resistant S. aureus are increasingly common in high school, collegiate, and professional teams.

Rosacea is another condition commonly treated with Rx products. What patients and physicians may not realize is that everyday products such as skin cleansers and moisturizers can dramatically affect the course of their condition.

"Proper skin care is an integral part of therapy," said James Del Rosso, DO, clinical assistant professor of dermatology at the University of Nevada School of Medicine, Las Vegas. "Just using gentle cleansers can make a significant difference in the appearance of the face and the course of the disease." He suggested products from Neutrogena, Aveeno, or Cetaphil. "As long as it is not irritating the skin, I'm happy with it."

Pharmacists may also get involved with one of the latest rosacea treatments, ultra-low-dose antibiotics. At very low dose, 40 mg per day in an extended-release formulation, tetracyclines exhibit anti-inflammatory activity but no antibiotic activity, said Del Rosso. The key is keeping serum levels below the antibiotic threshold.

"The controlled-release formulation is what counts," Del Rosso explained. "You do not get the same response by giving a simple 40-mg oral dose daily. This is one time you do not want to substitute."

Pharmacists are also likely to see more patients with psoriasis. New and expensive biologic agents are getting headline attention, Linda F. Stein-Gold, M.D., director of dermatology clinical research at the Henry Ford Health System in West Bloomfield, Mich. But a new wave of topical corticosteroid products will likely remain as first-line therapy because of rapid response and cost.

New research shows that calcineurin inhibitors such as tacrolimus ointment (Protopic, Astellas) and pimecrolimus cream (Elidel, Novartis) may be effective for facial psoriasis. Both products are approved for atopic dermatitis, but off-label use for psoriasis is growing. "These are great molecules," Stein-Gold said. "But they do not penetrate well, which makes them great for the face and in skin folds. You don't want to use strong steroids in those areas."