Home' Australian Journal of Pharmacy : Jan-Feb 2017 Contents moment”
eradicating it properly.”
In an ideal interaction, it would be
the pharmacist on the floor talking to
the patient about dosage, frequency
of application or dosage, and a
timeframe for eradication of the
infection, Logan says.
“That would be the gold standard—
dose, frequency and duration
alongside printed lifestyle tips and
other information, so that they
remember it when they get home.
“It’s a really good opportunity for a
white coat to be out there on the floor,
and to remind consumers of the value
of the pharmacy as a health centre in
“Pharmacists should be thinking
about what they can add to a sale that
will increase loyalty—and antifungal
is a good opportunity to have that
‘white coat moment,’ get out there
and have a meaningful talk.”
A valuable service
The Chemmart Pharmacy Samford,
north-west of Brisbane, is renowned for
its customer ser vice: in 2016 it took out
the Community Engagement award in
the Guild Pharmacy of the Year Awards.
The store’s Professional Care
Pharmacist, Jacqui Hagidimitriou,
is out on the shop floor most of the
time—alternating with owner K aren
Brown—and says that despite the
prevalence of self-selection in the
category, a lot of customers do not
understand their fungal condition or
how best to manage it well at all.
A pharmacist helping educate
customers on the subject is vital
because so many customers
incorrectly self-diagnose, or are
unaware of the significance of repeat
infections, Hagidimitriou says.
“Because of our forward dispensing
model I tend to be on the floor most
of the time, and so I make a point of
finding out what customers have come
in for,” she says.
“If they say, ‘antifungal cream,’
I would open up a conversation
about why they think they need an
antifungal, because there’s a lot of
misconceptions out there about what
fungal infections are.
“Some come in really scared,
because they think their ring worm is
a worm—they don’t realise that it’s a
colloquialism for a fungal infection,
because of that characteristic ring-like
appearance. They think they got it
from their cat.
“From a customer perspective,
they don’t realise that tinea isn’t just
a disease that affects the feet. They
don’t realise that tinea is just the
name for the fungal infection and
that you can get it any where, and
that it’s the same thing as jock itch
Tinea can appear on the foot
(Athlete’s Foot), body (ring worm),
nails, scalp, groin (jock itch) or the
The converse also applies: consumers
tend to assume any foot infection is
tinea as well, Hagidimitriou says.
“A nd a lot of people don’t realise
that fungus, like bacteria, live on our
body anyway—it’s when it gets the
opportunity to g row beyond what’s
normal that you get a rash.”
According to the American Academy
of Dermatology, about half of nails
with suspected fungus do not have a
fungal infection at all.
“As other nail conditions, such as
nail dystrophies, may look similar in
appearance, it is important to ensure
accurate diagnosis of nail disease
before beginning treatment,” the
Academy wrote for the Choosing
Wisely initiative, in suggesting several
dermatological issues which should
be questioned by health professionals
and patients before proceeding with
testing or treatment.
“By confirming a fungal infection,
patients are not inappropriately at
risk for the side effects of antifungal
therapy, and nail disease is
Once a fungal nail infection has
been identified, the customer needs to
have a conversation with a pharmacist
about realistic expectations of
treatment time and adherence to the
treatment regime, say both Logan
“This time of year, through until
about March, is ver y relevant for fungal
nail infections,” Logan says, due to
people wanting to wear open-toed
shoes in the summer months.
“The thing is that people have
always treated these infections very
haphazardly. You need to give them
really clear directions on eradicating
it properly, because the efficacy of the
preparation suffers greatly from the
poor adherence to the inst ructions.
“ You need discipline to treat them. It
can take six to nine months or more to
treat the infection topically.
“But if we get the interaction right,
we can show that we can give really
valid professional advice that improves
their outcome and ability to treat
Hagidimitriou cautions that topical
treatments available in pharmacy may not
be effective once the infection reaches
the lunula, and the customer may again
need to be referred to a doctor.
“A nd picking something they’re
going to be compliant with can be
difficult,” she says.
Fungal infections may seem relatively innocuous, but
globally, nearly 1.5 million people die from them each year—
more people than malaria, breast cancer or tuberculosis.
In mid-2016 scientists from Aberdeen presented
research at the “Killer Fungus” exhibit of the Royal Society’s
Summer Science Exhibition, which represented research
from 12 UK universities who lead the world in research into
Professor Neil Gow, world expert in fungal research at the
University of Aberdeen, led the Killer Fungus exhibit and said
that serious, life-threatening fungal infections are “more
common than people realise”.
“At the moment we have no fungal vaccines and a
relatively limited number of antifungal drugs for treating
serious fungal infections,” he says.
“ There is a pressing need to develop new treatments. We
also need to get better at diagnosing fungal infections.
“At the moment we’re not very good at making these
diagnoses early enough to save patients with life
Some fungal infections can also cause respiratory
problems or severe allergies and fungal infections in the eye
also lead to hundreds of thousands of cases of blindness
per year globally.
Serious fungal infections can carry higher risks, including
death. People who have suffered a trauma (such as an
accident which has resulted in an infected wound) and
people with weak immune systems (for example those being
treated with chemotherapy, by stem cell or bone marrow
transplantation or suffering from HIV-AIDS) may be more
vulnerable to the risk of serious infection.
In the UK alone it is estimated that about 14,000 people
may suffer from a serious fungal infection each year.
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