How special would you feel if your treatment plan from your friendly pharmacist is tailored just for you? Other than feeling special, an individualised treatment plan could very well accelerate your healing, both in body and mind.
1Twenty80 speaks to pharmacist Sim Lee Ping from Marina Pharmacy, Miri on individualised management plans and her approach on tackling dermatological issues.
In your opinion, what is the number one health issue that is faced by Malaysians?
Sim Lee Ping : I cannot comment on the number one health issue faced by Malaysians as it depends on the region, but I believe that metabolic diseases and skin disorders will be among one of the top few. They are often overlooked by the public and health professionals. One of the problems in our current healthcare setting in Malaysia is that it’s not patient orientated enough. We are all different so not all standard treatments will suit all patients. This also brings about the dilemma of whether the patients have been given adequate attention and time during consultation to enable the health professionals to really understand their health issues and then plan suitable management plans for them.
Why did you decide to focus on diabetes and dermatology at your pharmacy?
Lee Ping : Firstly, there are not many dermatologists, permanent endocrinologist, or diabetes educators in Miri and cities near here. Both my parents are Type II diabetics so I possibly have a chance to get Type II diabetes due to genetics. This drove me to pursue postgraduate studies in Diabetes Management after I finished my undergraduate degree.
Uncontrolled diabetes may lead to many complications including skin disorders like diabetic ulcers, dryness and itchiness. It is like a chain reaction that make me want to explore the dermatology side even more.
After nearly two years of tertiary teaching in University of South Australia, I shifted my career to the beauty field, giving me more opportunities to study the skin from a different perspective. With the accumulated studies and experience, I wanted to contribute to the local society.
Individualised management in the health sector has been widely talked about but very few countries have realised this because individualised programmes cost money and are time consuming. However, in my opinion, this is one of the new ways for the current independent community pharmacies to pull themselves out of the price war.
Price war is a huge issue in community pharmacies around the world and many small independent pharmacies fail to survive when challenged by chain outlets. If the service is the same, of course most people will go to cheaper options. By offering what others cannot, we have a way to fight for survival and growth.
Consultation fees can be charged to the patients to balance out the time we spend for the planning. As health professionals, we need to create our value to be appreciated. This will be a win-win situation for both the independent community pharmacists and consumers who can get better service and health outcomes through this.
“As health professionals, we need to create our value to be appreciated.”
Is psoriasis on the rise and how does it differ from eczema?
Lee Ping : I don’t know the exact figures of how many Malaysians are affected by psoriasis as many cases are undiagnosed but we are getting a few new cases each week. It’s been around nine months since Marina Pharmacy Miri has been established and we have nearly 30 cases of different types of psoriasis being referred to us and the number is growing each week. Psoriasis is an autoimmune disease leading to excessive and aggressive turnover of skin tissues whereas eczema is skin inflammation which is often linked to allergies. Both conditions are not contagious
What are common myths about psoriasis that your patients have believed?
Lee Ping : The most common myth is that psoriasis is contagious and from the public. This is untrue. I don’t really hear a lot of misconceptions as almost all of my patients have seen doctors or dermatologists for their condition and I believe that they have been properly educated.
What are the basic management steps for psoriasis and do these steps differ on where the psoriasis is placed?
Lee Ping : Well, my approach may be different from standard conventional practice as I combine complementary medicines and conventional therapy in the management plan.
To me, the patient must stabilise their immunity while treating the symptoms of the skin. Basically, they need to maintain a certain moisture level of the skin to reduce itchiness. This include using soap-free wash and a good moisturiser with or without urea. In terms of which moisturiser to choose, it depends on their current skin condition and allergies. Hence, a patch test is advisable when choosing the most suitable moisturiser for them. From my experience, the patient may feel stinging sensations when a moisturiser with urea or alcohol compound is applied to the skin when it is inflamed or injured.
Patients with long term strong steroid use are a little challenging because their skin is thinning and withdrawal from corticosteroid is necessary to prevent further damage. In this case, I will warn the patient about the withdrawal effects which may often occur when we cease the use of the topical corticosteroid. I would try to mimic the natural skin barrier by applying different layers of topical products to moisturise, reduce inflammation, prevent or treat infection and to seal up the skin.
My approach is 7-days-2-days rule whereby the topical corticosteroid is used for 7 days and have a break of 2 days by using steroid free products. I write my own steroid free formulae and compound it for patients. They consist of natural ingredients such as live probiotics, indigo naturalis, Vitamin E, Vitamin D and Oregon grape oil. However, I may also use some
commercial products like ichthammol, coal tar, calcipotriol to cover the steroid free period if the condition allows. Some herbal products like turmeric, sea cucumber, colostrum, and Vitamin D3 analogue, Oregon grape extract can be part of the treatment regime in some stages too. I also tell my patients to enjoy a salt bath whenever they can as it seems to help some psoriatic patients.
How does psoriasis differ in adults compared to children?
Lee Ping : Almost all of my psoriatic patients are adults. Some of them might have developed the condition since they were teenagers. Normally in children or young adults, psoriasis is triggered by streptococcal infections such as throat or skin infection, which sets off an immune system reaction that causes spots on the skin. They may find the psoriasis outbreak roughly a few weeks after the said infection. In this case, when it is picked up early, a course of antibiotics can be put on to clear the infection first. There are many other factors that can trigger psoriasis like genetics, immunological, stress, trauma, drugs, allergies and extreme temperatures leading to alteration of the body’s immunity.
When the immunity is altered, it can hardly be reversed based on today’s knowledge and technology. However, science is evolving and new treatments are discovered daily so there might be a better solution in the near future.
How can Malaysians be proactive in taking charge of their health?
Lee Ping : I feel that as Malaysians, we are blessed with an almost complete health system compared to many developing countries. There are resources freely available in this country, so people may read about their conditions through reliable sources on the internet, health magazines and newspapers. Please do not forget that your local pharmacists are one of the health professionals who you may seek the answers from and their advice is normally free of charge. However, we are just advisors. The person who can really make a difference is you! The patient is the one who needs to apply and follow the treatment regime daily. Compliance determines the results. In the case of young children, parents or carers play a crucial role in disease control and management. They need to be very patient with young children who suffer from skin disorders as constant discomfort may make the children very agitated.
