1. Which TWO of these can OTC hydrocortisone cream be sold?

A. for nappy rash for an 18-month toddler
B. a rash from shaving on a man
C. a woman with a nickel allergy rash on her wrist
D. vulval rash and irritation from bubble bath on a woman
E. for insect bites on a 9 year old
F. A man who has been self treating with hydrocortisone for the last month.
G. A 42 year old man who developed a rash on his legs from gardening.

2. A 48-year-old woman asks you to recommend a treatment for itching. The itchiness is widespread over her body and started about 2 days ago. She has a yellow-brown tanned appearance, and has returned from a holiday in Turkey 2 weeks ago. On questioning she reveals that she feels generally unwell and has difficulty sleeping. She does NOT take any medication and since returning from holiday she has not changed her diet, or used any new cosmetics or detergents. Which one of the following courses of action is the most appropriate for you to take?

A. advise her to take piriton (chlorphenamine/chlorpheniramine maleate 4mg) tablets?
B. advise her to use calamine lotion
C. advise her to use hydrocortisone cream 1%
D. advise her to use a soap substitute such as emulsifying ointment
E. advise her to see her GP

ANSWERS

1) Topical hydrocortisone is only licensed for OTC sale for over 10 years old. Therefore any age group below this should be referred.
- Topical hydrocortisone is not for OTC sale for the face, broken skin, mucus membranes, and sensitive areas of the skin such as the vulva.
- Directions to apply twice daily for 1 week. Any treatment longer than this should be referred.
Answer is C and G

2) The symptoms described are of jaundice. Jaundice is caused by liver failure, by bilirubin leaking out and depositing in the skin leaving a yellow colour and causing itching. The symptoms of jaundice should especially be reported to GP if they have just returned from a foreign country. The other options of OTC treatment may help reduce itching, but referral to a GP is the best course of action.
Answer is E