OTC Products For Skin Made by alaa belal

OTC Products For Skin Made by alaa belal Disorders

Fungal Infections Hyperkeratosis Canker sores Disorders Viral Infections Skin Infestations Secondary bacterial infections

Fungal Infections

Tinea 5 Types Pedis Corporis Capitis Unguium Versicolor

1 - Tinea pedis Athlete’s foot NOT just athletes !! But also: Weak immune system Older than 60 Diabetics

1 - Tinea pedis Athlete’s foot Interdigital Moccasin Most common type Itching Scaling Between two smallest toes Burning Vesicular Maceration & Foul odour

1 - Tinea pedis Athlete’s foot Interdigital Moccasin Vesicular Itching Scalin Dryness Absence of vesicles g Involve the entire sole of the foot and extend onto the sides

1 - Tinea pedis Athlete’s foot Interdigital Moccasin Vesicular Least common Fluid-filled blisters Patient can not walk Itching Scaling

Differential diagnosis Tinea pedis Eczema Inflammation, endogenous cause Differences: Redness 1) Edema 2)Oozing Blister 3)No foul odour Similarities: Itching Crusting

3 - Tinea corporis Ringworm 1)Anywhere except face, feet, hands, groin 2)Outer part of the sore can be raised, scally red, may contain vesicles, middle part normal Grows outwards, may overlap Scaling Itching

Differential diagnosis Tinea corporis Discoid eczema Differences : 1)Occurs on arms, hands & feet 2)smaller 3)Middle part is not normal 4)Rare in patients under 20 years

Differential diagnosis Tinea corporis Psoriasis Immunological problem Differences: Not contagious Red plaques covered with silverywhite scales Painful and sometimes crack &bleed Similarities: Itching Scaling

4 - Tinea capitis Ringworm of the scalp Round, bald patches Scaling, itching More common in children

5 - Tinea unguium Onycholysis, fungal nail infection 1)Turn yellow or white 2)Get thicker

6 - Tinea versicolor Pityriasis versicolor Yeast pitysporum orbiculare Common in oily surfaces teenagers Cosmetic concern Not contagious

Differential diagnosis Tinea versicolor Flat Hypo- or hyperpigmentation Slight itching and scalling Not painful Vitiligo Found on fingers, toes, knees, and around the eyes and mouth Loss of all color (depigmentation) No scaling

Transmission of tinea Prevention 1. Dry off well 2. Do not wear occlusive clothes 3. Wear shower at public showers and sandals swimming pools Water

Transmission of tinea Prevention Do not share clothes, socks, towels, nail clippers Indirect contact

Transmission of tinea Prevention Avoid contact with infected people or animals Direct contact

Transmission of tinea Autoinfection

Treatment

Treatment of all fungal infections Objective Prevent recurrence Inhibit the growth of fungus Relieve itching, burning and other symptoms

Pharmaceutical Treatment Most fungal infections Topical OTC cream, solution, spray, powder Except Scal p Nail Oral prescription

Oral prescription Itraconazole

Oral prescription Fluconazole

Oral prescription Disadvantages Very expensive Side effects

Treatment of nail infection (Tinea unguium) Under 18 years Nail dystrophy or destruction Refer if to a periphera dermatologist More l than 2 infected nails circulator y disorders Pregnanc y or breast feeding diabete s mellitus Unrespon -siveness treatment Deficienc y in immune system

Treatment of nail infection (Tinea unguium) lamifen Oral Nail polish Ticonazole Surgically

Nail polish Cleaning Cutting Apply Twice daily, for 3 months

Treatment of scalp infection (Tinea capitis) if Refer to a Swollen dermatologist mass discharging pus Severe alopecia Swollen tender lymphocyte of the neck

Treatment of scalp infection (Tinea capitis) Oral prescription Preventing reinfection Shampoo If treated early, the hair will grow back

Treatment of tinea versicolor Skin may not regain its normal pigmentation Commonly comes back after treatment

Treatment of tinea versicolor Selenium sulfide Sulfiselen® Tinasel® Areas affected lathered by selenium sulfide for about 2 -5 mins then washed thoroughly Used daily for up to 2 weeks

Tinea versicolor Tinea capitis Tinea unguium

Treatment Azoles Thiocarbamate s Allylamines Clioquinol Undecylenic acid Povidone iodine Miconazole nitrate 2%

Treatment Azoles Thiocarbamate s Allylamines Clioquinol Undecylenic acid Povidone iodine Ketoconazole 2%

Treatment Azoles Thiocarbamate s Allylamines Clioquinol Undecylenic acid Povidone iodine Available in all dosage forms Broad spectrum antifungal Apply twice daily 2 weeks for skin infection 4 weeks for foot 6 weeks for scalp few months for nail infection Miconazole (Daktarin®) safe in pregnancy

Treatment Azoles Thiocarbamate s Allylamines Clioquinol Undecylenic acid Povidone iodine Tolnaftate 1%

Treatment Azoles Thiocarbamate s Allylamines Clioquinol Undecylenic acid Povidone iodine Cream and solution only Effective against most dermatophytes not only t. versicolor or candidiasis

Treatment Azoles Thiocarbamate s Allylamines Clioquinol Undecylenic acid Povidone iodine Terbinafine 1%

Treatment Azoles Thiocarbamate s Allylamines Clioquinol Undecylenic acid Povidone iodine Cream, solution, spray tablets (but not otc) Cream 1 -2 times: 1 week for T. pedis 2 weeks for T. corporis T. versicolor Not for children <16 or breast feeding mothers

Treatment Azoles Thiocarbamate s Salt of aluminium clioquinol 3% Allylamines Clioquinol Undecylenic acid Povidone iodine Clioquinol + corticosteroid

Treatment Azoles Thiocarbamate s Allylamines Clioquinol Undecylenic acid Povidone iodine Lotion, cream, ointment Side effects of clioquinol: • May cause itching, allergic contact dermatitis • Interfere with thyroid function Do not use <2 years

Treatment Azoles Thiocarbamate s Allylamines Clioquinol Undecylenic acid Povidone iodine Undecylenic acid 10% and 25% Fungistatic Ointment at nighttime Powder at daytime

Treatment Azoles Thiocarbamate s Allylamines Clioquinol Undecylenic acid Povidone iodine 10%solution (Betadaine®)

Candidiasis

Candidiasis Most common type of yeast infection More than 20 species Candida Most common albicans (Monilia) Causes Oral thrush Vaginal candidiasis

Oral candidiasis (Oral thrush) (Moniliasis) Symptoms Thick, white lacy patches on top of a red base Where ? ? Tongue Palate Or elsewhere inside the mouth

Treatment Topical oral antifungal 1 - Miconazole 2 - Nystatin

Treatment 1 - Miconazole Daktarin® oral gel Miconaz® oral gel

Treatment 2 - Nystatin

Quiz VSSuspension ? ? Oral gel “ Oral gel is recommended rather than suspension or drops due to longer residence on the affected area , as it adheres to the mucosal lining ”

Dose ¼ spoonful ½ spoonful Infants Adults Treatment is continued for at least a week after symptoms have disappeared

Contraindication liver disfunction safety not assured

Canker sores Aphthous stomatitis

Symptom s 1 - Size Minor 5 -8 mm Major ? ? > 1 cm 2 - Shape Oval - round 3 - Color White - yellow 4 - Where ? Tongue, cheek and lip

Cause Unknown Canker sores is an idiopathic disease

Triggers Oral trauma Stress Hormonal changes Smoking cessation Food Helicobacter pylori Risk groups Being female Family history

Treatment Then we will give our OTC consultancy No other extreme conditions Make sure it’s canker sores

Differential diagnosis 1 - Major canker sores Greater than or 1 cm 10 separate, may coalesce into a single very large ulcer May take up to six weeks to heal and leave extensive scarrin

Differential diagnosis 2 - Herpetiform canker sores Clusters of 10 to 100 sores

OTC Treatment Local anaesthetic Topical oral analgesic Anti-inflammatory Antiseptic and disinfectant agent The magic drug

Local anaesthetic Viscous lidocaine Oracure® oral gel Applied directly to the lesions Spray is not suitable for children

Topical oral analgesic Mundisal® gel

Topical oral analgesic BBC® spray

Anti-inflammatory Kenalog® in orabase

Antiseptic and disinfectant agent Corsodyl® dental gel as chlorhexidine digluconate

The magic drug Self Healing

Patient counseling Rinse your mouth with salty solution Baking soda !! Ice !!

Skin infestations

Scabies A very common skin infection affects people of all races and social classes. Cause: Microscopic mite called Sarcoptes scabei

Scabies Symptoms 4 Itching Red papular rash Rash can also include vesicles Secondary bacterial Greyish “pencil-like” burrows infection Take from 4 to 8 weeks Take from 1 to 4 days to appear in patients who have not been infected previously Patients who have scabies before

Scabies Transmission Direct way Prolonged skin-to skin contact Indirect way By sharing articles Scabies spreads rapidly in crowded places As: hospitals, schools and prisons. Animals such as dogs and cats are not a source of spread of human scabies. ( Why do you think? )

Head lice ( Pediculosis) Cause: Small wingless parasitic insect Pediculus humanus capitis

Head lice Symptoms 4 Feeling of something moving in the hair. Itching due to allergic reaction because of lice saliva. Irritability and diffulity sleeping. Sores on the head caused by scratching. (Secondary bacterial infection? !)

Head lice Transmission Common way By person-to-person contact. Uncommon way By contact with clothes or other personal items used by infected persons. 1. Most common among preschool children, elementary school children and between household members. 2. Animals such as dogs and cats do not play a role in transmission of human head lice.

Treatment Pediculicides/scabicid es Antipruritics Permethrin Topical antipruritics Malathion Systemic antihistaminics Piperonal d-phenothrine

Treatment Permethrin Scabies 2. 5 -5% Permethrine® Ectomethrine® Pediculosis Up to 1% Permethrin licid®

Treatment Malathion 0. 5 lotion (Ovide®) d-phenothrine 0. 4% (Item shampoo) Eradication of lice & nits from the scalp (head lice).

Treatment Precautions 1 - Avoid application to wounded skin or scalp to avoid systemic absorption 2 - Avoid scratching rash or vesicles & keep open sores clean

Treatment Pediculicides/scabicid es Antipruritics Permethrin Topical antipruritics Malathion Systemic antihistaminics Piperonal d-phenothrine

Treatment Antipruritics Helping provide relief of itching Topical Calamine lotion Crotamitone lotion Systemic Atrax antihistaminic Zyrtec Phenergan

Viral Cutaneous Infections

Herpes simplex (Cold sores or sun blisters) HSV-1 causes: Herpetic labialis (cold sores) Herpetic whitlow Herpetic keratitis HSV-2 causes: Genital lesions genital lesions and the virus is never eliminated from the body because The virus stays in the ganglia in an inactive form.

Prevention A vaccine called Zostavax to reduce the risk of shingles in people ages 60 and over. Varivax is the live attenuated vaccine that produces persistent immunity against chicken pox. Killed and sub unit vaccine may be used to prevent recurrence of herpes simplex virus.

Treatment Acyclovir Zovirax Penciclovir

Hypertrophy of the horny layer of the Hyperkeratotic skin (excessive development of keratin) disorders

Callus caused by Skin lesions Excess friction Over a broad area of skin

Hand callus Callus Repeated handling of an object that puts pressure on the hand Lack a central core Feet callus Pressure from footwear

Warts HPV Skin growth caused by Very contagious Go away on their own within months or years

Warts Common Plantar Grow most often on the hands Rough, shaped like a dome, and greyish-brown in color. Grow on the soles of the feet Hard, thick patches of skin with dark specks

Treatment ? ?

diabete s mellitus oozing purulent materials periphera l circulator y disease rheumato -id arthritis hemorrha -ging Hair growth Refer to a dermatologist

Treatment (keratolytic agent ) Mechanism of action : ? ? Freezing method Salicylic acid It decreases keratinocyte adhesion It increases water binding , which leads to a hydration of keratin Dimethyl ether (freezed)