OTC Products For
Skin Disorders
Made by alaa belal
Fungal Infections
Hyperkeratosis
Canker sores
Disorders
Viral
Infections
Skin
Infestations
Secondary bacterial
infections
Fungal Infections
Tinea
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
Between two smallest toes
Scaling
Burning
Vesicular
Maceration & Foul odour
1- Tinea pedis
Athlete’s foot
Interdigital
Moccasin
Vesicular
Itching Scaling
Dryness
Absence of vesicles
Involve the entire sole of the foot and extend onto the sides
1- Tinea pedis
Athlete’s foot
Interdigital
Moccasin
Least common
Fluid-filled blisters
Itching
Scaling
Vesicular
Patient can not walk
Differential diagnosis
Tinea pedis
Eczema
Inflammation, endogenous cause
Differences:
Redness 1) Edema
3)No foul odour
Similarities:
Itching Crusting
2)Oozing
Blister
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
Vitiligo
Tinea versicolor
Flat
Hypo- or hyperpigmentation
Slight itching and scalling
Not painful
Found on fingers, toes, knees, and
around the eyes and mouth
Loss of all color (depigmentation)
No scaling
Transmission of tinea
1.
2.
3.
Prevention
Dry off well
Do not wear
occlusive clothes
Wear shower sandals
at public showers and
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
Scalp
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
dermatologist
More
peripheral
than 2
infected
nails
circulatory
disorders
Unresponsiveness
treatment
Pregnancy
or breast
feeding
diabetes
mellitus
Deficiency
in immune
system
Treatment of nail infection
(Tinea unguium)
Oral
lamifen
Nail polish
Ticonazole
Surgically
Nail polish
Cleaning
Cutting
Apply
Twice daily, for 3 months
Treatment of scalp infection
(Tinea capitis)
if
Refer to a
dermatologist
Swollen 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
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Miconazole nitrate 2%
Treatment
Azoles
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Ketoconazole 2%
Treatment
Azoles
Thiocarbamates
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
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Tolnaftate 1%
Treatment
Azoles
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Cream and
solution only
Effective against most
dermatophytes not
only t.versicolor or
candidiasis
Treatment
Azoles
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Terbinafine 1%
Treatment
Azoles
Thiocarbamates
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
Thiocarbamates
Salt of aluminium
clioquinol 3%
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Clioquinol + corticosteroid
Treatment
Azoles
Thiocarbamates
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
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Undecylenic acid 10%
and 25%
Fungistatic
Ointment at nighttime
Powder at daytime
Treatment
Azoles
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Povidone iodine
10%solution
(Betadaine®)
Candidiasis
Candidiasis
Most common type of yeast infection
More than 20 species
Candida albicans
(Monilia)
Most common
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
Oral gel
“
VS Suspension
??
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
Symptoms
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 1cm
10 separate, may coalesce into a single very large ulcer
May take up to six weeks to heal and leave extensive scarring
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
Itching
Red papular rash
Rash can also include vesicles
Secondary bacterial infection
Greyish “pencil-like” burrows
Take from 4 to 8 weeks
Take from 1 to 4 days
to appear in
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
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/scabicides
Antipruritics
Permethrin
Topical antipruritics
Malathion
Systemic antihistaminics
Piperonal
d-phenothrine
Treatment
Permethrin
Scabies
2.5-5% Permethrin
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
Treatment
Pediculicides/scabicides
Antipruritics
Permethrin
Topical antipruritics
Malathion
Systemic antihistaminics
Piperonal
d-phenothrine
Treatment
Antipruritics
Helping provide relief of itching
Topical
Calamine lotion
Crotamitone lotion
Systemic antihistaminic
Atrax
Zyrtec
Phenergan
Viral Cutaneous Infections
Herpes simplex
(Cold sores or sun blisters)
HSV-1causes:
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 skin
Hyperkeratotic
(excessive
development of keratin)
disorders
Callus
Skin lesions caused by
Excess friction
Over a broad
area of skin
Callus
Hand callus
Repeated handling of an object
that puts pressure on the hand
Lack a central core
Feet callus
Pressure from footwear
Warts
Skin growth caused by HPV
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
??
diabetes
mellitus
oozing
purulent
materials
peripheral
circulatory
disease
rheumatoid arthritis
hemorrhaging
Hair
growth
Refer to a
dermatologist
Treatment
(keratolytic agent )
Mechanism of action :
??
Salicylic
acidadhesion
It decreases
keratinocyte
It increases water binding ,which
leads to a hydration of keratin
Freezing method
Dimethyl ether (freezed)
Precautions
Avoid using salicylic acid, if you are
allergic to
NSAIDs
(aspirin, ibuprofen, ….); or if you have any
other allergies
Secondary Bacterial Infection
SBI
Which bacteria causes SBI
Staphylococcus aureus
Streptococcus pyogenes
Staphylococcus aureus
Impetigo (school sores)
Staphylococcus aureus
Folliculitis
Staphylococcus aureus
Furunculosis (boils)
Which bacteria causes SBI
Staphylococcus aureus
Streptococcus pyogenes
Streptococcus pyogenes
Cellulitis
Streptococcus pyogenes
Erysipelas
Streptococcus pyogenes
Necrotising fasciitis
Treatment
Bacitracin Zinc
Neomycin
Polymyxin B Sulfate
Tetracycline
Fusidic acid
Tetracycline
Fusidic acid
Terramycin
Fucidin
Thanks