OTC Dermatological Products

1. Dermatitis
2. Sunburn or suntan

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 mÉÉ
Contact dermatitis
&
Scaly dermatosis

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By the end of this lecture, students should be able to:

• Identify role of OTC agents in contact dermatitis

• Recognize OTC agents used in dandruff and
Seborrheic dermatitis
• Identify the role of OTC agents in Psoriasis
• Discuss OTC agents used for treatment of mild
psoriasis.

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 I. Contact dermatitis
Types
a. Irritant contact dermatitis
• Caused by direct contact with a primary irritant.
• Irritants can be classified into:
1) Absolute primary irritants: injure, on first contact, any
person’s skin. E.g. (strong acids, alkalis, other industrial
chemicals).
2) Relative primary irritants: Irritants less toxic, require
repeated or prolonged exposure to provoke a reaction. E.g.
(soaps, detergents, benzoyl peroxide, certain plant and
animal substances)
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 b. Allergic contact dermatitis
Many plants, any chemical, can cause allergic contact
dermatitis.
E.g. Poison ivy Cause T cell–mediated allergic reaction.

c. Photo dermatitis

d. Contact urticaria
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 Phases of contact dermatitis
a. Acute stage: Wet lesions (blisters and weeping skin, are evident
in well-outlined patches). Also evident are erythema, edema,
vesicles, and oozing.
b. Subacute stage: Crusts or layers form over the previously wet
lesions.
c. Chronic stage: In this phase, the lesions become dry and
thickened. Initially, dryness and fissuring are the signs. Later,
erythema, and abrasions appear.

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 Treatment
❑A patient with a poison ivy eruption should be referred to a
physician if:
• The eruption involves a large area of the body (about 25%),
involves the eyes, genital area, mouth, or respiratory tract .
• And For severe eruptions.

❑For a less severe eruption, the principal goals are to relieve

the itching and inflammation and to protect the integrity of the
skin.

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 A) Drugs to relieve itching
1. Oral H1-receptor blockers: diphenhydramine
2. Topical hydrocortisone up to 1%, antipruritic and anti-
inflammatory. Avoid its use >7 days.
3. Counterirritants: camphor, phenol and menthol They act as
analgesic and antipruritic.
4. Astringents: mild protein precipitants decreases the local
edema& inflammation. (aluminum acetate, Calamine).

❑Calamine is zinc oxide with ferric oxide; which provides the pink
color) It contracts tissue and helps dry the area.
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5. local anesthetics: benzocaine (5% to 20%) relieve itching for
short duration (30 to 45 mins), useful at bedtime, when pruritus is
most annoying.

6. Topical antihistamines diphenhydramine may provide relief of

mild itching principally through a topical anesthetic effect rather
than antihistamine effect.

“Topical and oral diphenhydramine should not be used

concurrently”

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 B) Basic treatment
1. Acute (weeping) lesions
❑Wet dressings: water evaporating from the skin cools it and
relieves itching.
❑Aluminium acetate as a wet dressing or a cool bath of 15 to 30
mins. for 3-6 times/day provides antipruritic effect.
❑Colloidal oatmeal baths antipruritic effect.

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 2. Subacute dermatitis
1. A thin layer of hydrocortisone cream or lotion (0.5% to 1%) may be
applied 3-4 times/day.
2. Topical anesthetics, may be used.
3. Chronic dermatitis
• Treated with hydrocortisone ointment no more than 7 days.
C) Prevention
1. Prevent contact.
2. Bentoquatam , an organoclay lotion applied at least 15 mins before
contact with the plant and then every 4 hrs. for continued protection.

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 II. SCALY DERMATOSES “hyperproliferative disorders,”
• Diseases affecting the epidermis.
• Patients have higher levels of Pityrosporum (a fungus that is found in the normal flora of
the skin and scalp).
• The three primary scaly dermatoses are
a. Dandruff
b. Seborrheic dermatitis
c. Psoriasis
A. Dandruff
• Cell turnover rate is 13 to 15 days.
• Symptoms: Scaling and pruritus, Starts at puberty or later and peaks in early adulthood.
❑Treatment: Daily washing with Non-medicated shampoos: for mild dandruff. Medicated
shampoos For moderate-to-severe dandruff
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• twice weekly for the first 2 to 3 weeks.
 i. Cytostatic agents
• Decreasing the rate of epidermal cell turnover.
1. Coal tar shampoo, lotion, cream, ointment, foam, and soap in
strengths 0.5% to 5.0%.
• Mechanism of action: cross-link with DNA and inhibit cell division.
• carcinogenic, May cause photosensitivity and folliculitis.

2. Selenium sulfide
Possesses cytostatic and antifungal activities.
• Can leave scalp unusually oily.
• Available as shampoo, lotion, and foam in concentrations from 1.0%
(OTC) to 2.25% (via prescription).
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 3. Pyrithione zinc (Head & Shoulders Dry Scalp)
• Cytostatic activity prevents epidermal cell growth and
multiplication.
• Also possesses antifungal activity.
• May be applied to scalp and skin.
• Shampooing- 0.3% to 2.0%.
• creams and lotions- 0.1% to 0.25%.

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 ii. Keratolytic agents
• dissolve or break down the outermost layer of skin, causing peeling of the
stratum corneum.
a) Salicylic acid: Decreases skin pH, thereby increasing the movement of water
into the stratum corneum, which loosens and removes epidermal cells.
Available for the treatment of scaly dermatoses at concentrations between
1.8% and 3%.

b) Sulfur: antimicrobial/antifungal, Approved as a single agent for the

treatment of dandruff , but commonly marketed in sulfur/salicylic acid
combination products (sulfur concentrations between 2% and 5%).

c) Sulfur/salicylic acid combination: individual ingredients may not exceed FDA-

approved limits for treatment of dandruff.
 iii. Ketoconazole
• Treatment of dandruff and seborrheic dermatitis due to its activity against
Pityrosporum
• leave at least 3 days between each time it is used
• Avoid use in patients<12 years old and those who are nursing or pregnant
(safety, efficacy not established)
• Available as OTC-strength (1%) and prescription-strength (2%) shampoos.

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 B. Seborrheic dermatitis
• characterized by dull, greasy, yellowish-red scales
• Can affect the scalp, face, ears, back, upper chest, axillae, and groin (areas
with high concentrations of oil-producing glands).
• scaling and pruritus are most common symptoms
• Increase by poor health and stress.

Treatment
1. Medicated shampoos: Coal tar, Pyrithione zinc, Salicylic acid, Selenium sulfide,
Ketoconazole /
2. Topical corticosteroids OTC hydrocortisone (1%) (adjunct therapy, used on affected
areas 2-3 times/ day, no more than 7 days.
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 Cradle cap
• Infantile seborrheic dermatitis is known as “cradle cap.”
• resolves when infant reaches 12 months
• shampoo the scalp frequently with baby shampoo
• In more severe cases, a small amount of emollient (such as mineral oil, baby
oil, vegetable oil, or white petrolatum jelly) may be applied to the scalp to
help loosen and remove outer layer.
• Severe cases require treatment with hydrocortisone (prescription only)

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 C. Psoriasis
• Cell turnover rate is 3 to 4 days.
• forms of psoriasis: plaque ,
• characterized by light pink/maroon-colored plaques covered with
silvery scales, most commonly found on the elbows, knees, back,
scalp, and external ear canal.

• Symptoms: Itching and irritation , may be

asymptomatic.
• Triggering factors: infection, stress, drugs (NSAIDs,b-
blockers, anti-malarials, lithium, and withdrawal from
corticosteroid therapy).
• Smoking, alcohol use, obesity increase the severity of 19
the disease.
• Only mild Treatment
cases are indicated for self-treatment.
1. Non-pharmacological measures
• Counsel Patient to soak in lukewarm water several times a week and
to apply emollients (such as petroleum jelly) to the affected areas
immediately after bathing.
• lose weight, smoking cessation , avoid alcohol consumption, reduce
stress
2. Coal tar and salicylic acid preferred for psoriasis limited to the scalp
area.
3. Hydrocortisone its use should be limited to small areas of the body
and should not be used for more than 7 days without prior prescriber
approval.
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Sunlight, Sunscreens and
suntan products

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 Sunlight, Sunscreens and suntan products
By the end of this lecture, students should be able to:
• Identify the non-prescription topical agents used for treatment of
sunburn.
• Recognize types of Drug-induced photosensitivity reactions and how
to prevent them
• Differentiate between photo-dermatosis and photo-aging
• Discuss types sunscreen agents

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a. UVA (320 to 400 nm)
➢UVA I (340 to 400 nm) less erythrogenic and less melanogenic .
➢UVA II (320 to 340 nm). similar in effect to UVB.
• Uses: UVA is used in tanning and in treatment of psoriasis.

B. UVB (290 to 320 nm) causes the sunburn and tanning. Small
amounts of this radiation are required for normal vitamin D
synthesis in the skin.

c. UVC (200 to 290 nm) does not reach the earth’s surface because
most of it is absorbed by the ozone layer. Artificial UVC sources
(mercury arc lamps) can emit this radiation.
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 1- Sunburn
1. mild (a slight reddening of the skin)
2. severe (pain, swelling, formation of blisters)

2- Suntan
it result of two processes.
a. Oxidation of melanin, which is already present in the epidermis.
b. Stimulation of melanocytes to produce additional melanin, which
is subsequently oxidized on further exposure to sunlight.
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 Drug-induced photosensitivity reactions
Photosensitivity is increased skin reactivity to light .
1. Photo-allergy reactions (immune mediated) UV exposure change
the structure of the drug, seen by the body as Antigen, allergic
response is initiated, cause inflammation of the skin in light-exposed
areas).

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2. Photo-toxic reactions (Direct damage to
tissue):
❑Some drugs may produce both types
of reactions. (thiazides, tetracyclines,
phenothiazines, sulfonamides).

❑Standard sunscreens do not prevent

drug-induced photosensitivity.

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 Sunscreen products
1. SPF-15 blocks 93% of UVB rays, SPF-30 blocks 97% of the UVB
rays. any benefits derived from using sunscreens with SPF>30 are
negligible.
2. The FDA’s requires sunscreens with an SPF>50 to be labeled as
“SPF 50+” as clinical evidence suggests no additional UV
protection above SPF 50.
3. The American Academy of Dermatology recommends that adults
and children use sunscreens with an SPF of at least 30.
❑A minimal sun protection product has an SPF of 2 -< 12;
❑a moderate sun protection product has an SPF of 12 -<30;
❑a high sun protection product has an SPF of ≥30.
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• Sunscreen can prevent squamous cell carcinoma.
• Hypersensitivity to sunscreen agents: Discontinue use if signs of
irritation or a rash occur.
• Do not use these products on infants <6 months of age.
• Recommend sunscreen products that are broad-spectrum
sunscreens (block both UVB and UVA).
Types of sunscreen agents
1. Physical sun blocks: opaque formulations that reflect and scatter
up to 99% of light in both the UV and visible spectrums (290 to 700
nm). Examples titanium dioxide and zinc oxide.
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 2. Chemical sunscreens:
❑act by absorbing a specific portion of the UV light spectrum
to prevent it from penetrating the skin.

❑Types: Agents absorb UVB rays.

Examples: p-aminobenzoic acid and oxybenzone.

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 ESSENTIAL READINGS
• Bertman G Katzung, Anthony J trevor. Basic and clinical
pharmacology. McGraw Hill. 13th edition, 2015.
• L. Shargel, A.H. Mutnick, P.F. Souney and L. Swanson. Comprehensive
Pharmacy Review; Lippincott Williams & Wilkins, 8th edition. Wolter
Klewer 2012.