Skin OTC

By : DR Mai Mosaad
Acne vulgaris
introduction :
The dermis of the skin consists of hair follicle
and associated by sebaceous gland these glands
secrete sebum “mixture of fats and waxes “
function :
to protect skin and hair by retarding water loss
and forming a barrier against external agents
Causes
 During puberty the production of androgenic
hormones increase in both sexes and levels of
testosterone increase
 Testosterone is taken up into the sebaceous
glands where it is converted into
dihydrotestosterone
 Stimulating the glands to secrete increased
amounts of sebum
Causes Continue
At the same time the keratin in
the epithelial layer becomes
more cohesive
So the sebum accumulates with
in the wall forming keratin plugs
Black heads – keratinized
material
White heads inflamation
Site of apperance : head ,
neck ,chest , arm
 Drugs may cause acne
Phenytoin “ ipanten “ ‫عالج ل لتشنج و‬
‫ت لقلب‬
‫ا لصرع و عدم انتظام ض ربا ا‬
Azathiprin “imuran “‫ف لمناعه ف ى‬‫ي ضع ا‬
‫حا التزراعه ا العضاء‬
Progestens
Rifampycin “ antibiotic “
Treatment
Avoid :
 peanuts , chocolate , fatty food , spice
food
Make up ‘cheap products ‘ for long time
Exposure to sun lights for long periods
Topical soaps and cleansers
Topical soap :
Synobar soap
Natry soap
Dose : 2 times daily
Cleanser :
Teen derm gel
Synobar
Cleanance
Dose :2 times daily
Topical antibiotics
Erythromycin
Ex : acnebiotic lotion - acnecare cream
Clindamycin
Ex : clinda sol solution - clindacine gel
Dose : 2 times daily for ½ h then wash
skin
Oral antibiotics
Used in case of moderate acne that do not respond
Doxycycline
Ex: Doxymycin caps - vibramycin caps -Doxy MR
Dose : first day 2 caps at one then use 1 caps daily for 6
months
Avoid using during pregnancy and lactation and in
children

Topical keratolytic agent
Tretinoin
It is a derivative of vitamin A it
makes the skin cell divide more
rapidly and new cells replace the
cells of existing pimpls
It cause irritation to the skin
Dose : first time 10 minutes
then wash , next day 15 minute
and so on if no improvement we
can use a higher concenteration
Avoid : sun lights , use at night
Topical keratolytic agent
Ex : tretinoin 0.025 % - 0.05
%
Retin-A gel
- acne free gel
– acretin cream
Systemic tretionin
Used in case of moderate acne and severe and
resistant acne
Isotretinoin
Ex : net look 10, 20, 40 - isotretinoin 10, 20
Dose : 0.5 to 1 mg /kg
Ex : 70 kg * 0.5 = 35 mg so , 20 mg 2 times daily
Not used in pregnancy as it cause terratogenic
effect to fetus
Refer is better in that case
Side effects of isotretionin
Dry lips & eyes
Elevated lipids (cholesterol and LDL )
Elevated liver enzymes ‘avoid using
with patients with liver disease ‘
Diminished night vision
Topical keratolytic agent
Azelic acid
Less irritant
Ex : azaderm cream – ezalic cream
Adapalene
less irritant
Oral zinc &vitamins
Vitazinc caps
Dose : one caps daily
Help to regenerate cells and
decrease oil secreation ,
antioxidant
Sulpher
Is keratolytic and
antiseptic
Ex : sulphur soap
 : dermovera lotion
Salicylic acid
Used in concenteration up to 2 % in acne treatment
Used combined with sulphur in some formulations
Has bacterostatic effect , anti inflammatory
effect
Cause increase in skin hydration
Ex : dermovera lotion
Salicylic acid soap
Eczema &dermatitis
Symptoms:
Dryness , erythema, itching often with crusting ,
swelling , vesicles and skin fissures
Eczema :
Chronic fluctuating inflammatory condition
of the skin with no known cause although
there is often a genetic link and a family
history of allergic sensitivity
Dermatitis :
Reaction to external
agents ,there are two
types irritant & allergic
:
Irritant dermatitis
 As a result of direct damage of skin due to
exposure to strong irritant
 Once the outer keratin layer of the skin has
been damaged irritant substance are able to
pass into the cells of the epidermis and cause
inflammatory reaction
 Ex : detergents , cleaning materials
 The condition can be chronic by wetting of the
skin
Allergic dermatitis
Is the result of hyper sensitivity
to a sensitizing agents
It can occur after a couple of
exposures , once established
sensitivity usually remains for life
Ex : rubber cement allergy
‫حساسيه ا لغ راء ا لموجود ف يا الحذيه‬
 Atopic dermatitis
Atopy :
refers to the genetic tendency to develop allergic diseases such as
allergic rhinitis, asthma and atopic dermatitis (eczema).  Due to
immunity deficiency

Ex : children under year “ cheeks erythema and itching
‘

Children over year “ itching specially at knees and
elbow “ increase by eating ex: strawberry , mango …..

Disappear at age 6 may appear in adults but with low
percentage
Treatment
1. Avoid irritant materials as cement ,
nickel ,,
2. Avoid eating irritant food as
strawberry ,chocolate , banana ….
3. Avoid itching as possible to prevent
2ry bacterial infection
Treatment
Topical steroids :
Betaderm cream
Betnovate cream
Dose : 2 times daily for max . 5 days
Not used for : face
axilla and groin
children
In order not to increase systemic absorption and skin atrophy

We can use non fluorinated steroids instead

Non fluorinated steroids
Ex : hydrocortisone 1% cream
 : elocon cream ‘ alcometasone ‘
 : perderm cream ‘ perdnicarbate ‘
 dermatop cream ‘ mometasone ‘
In case of 2ry bacterial
infection we can use
Corticosteroid + antibacterial
Ex : fucicort
 : defucin cream
We could not use corticosteroid in case of
injured skin
So we use antibiotic only as :
Fusiderm
Fucidin
Topical antihistamies
Fenestil gel “ dimethindene “
Allergyl cream “
chloropheniramine “
Oral anti histamines
First generation antihistamine :
Have sedative effect , so we can use in children

Side effects :
Tachy cardia
Sedation
Constipation
Urine retention
1 generation anti histamine
st
Ex : tavegyl “ clemastine “
 :Allergyl “ chlopheniramine
Dose : 1 tab or 1 table spoonful before sleeping

Fenistil drop
Dose : 10 drops 2 times daily
Fenistil syrup
Dose : 1 table spoonful 2 times daily
Can be used in case of children less than 2 years
2 generation anti histamine
nd
Less sedative effect
Ex : zyrtec ‘ cetrizine ‘
 : claritine ‘lortadine ‘
 : mosedin ‘ lortadine ‘
 : lorano ‘lortadine ‘
 : fexon ‘ fexofenadine ‘
 : telfast ‘ fexofenadine ‘
 dose : 1 tab – t table spoonfull before sleeping
Fexofenadine is better used in case of patients with liver and
kidney disease
Soothing agents
Calmyl lotion
Bringo lotion
Aloepanthen cream
Panthenol cream

Soap , shower gels “ bubble bath products “should be
avoided because it may cause excessive dehydration
of skin and skin sensitization
 Napkin dermatitis
Symptoms :
Inflammation , reddness of the skin
Due to contact dermatitis (irritation
from urine)
And may be fungal infection too
Prevention
We should keep the baby dry
Change the napkin type as it may be “allergy to
the napkin “
Using soothing creams ex : zinc olive cream
every time of napkin changing
Expose the baby to air before using napkins


Treatment
Using anti fungal + weak corticosteroid
Ex : Dermatin –cort cream (clotrimazole +
hydrocortisone )
 : Miconaz H cream ( miconazole +hydrocortisone )
 : Dakta cort cream (miconazole +hydrocortisone)
 : Momenta cream ( gentamycin + miconazole
+mometasone )
Avoid using kenacomb cream as it contains strong
corticosteroid not suitable for children
 Urticaria
Kind of skin rash
Symptoms : red , raised , itchy bumps they may
also burn or sting
Causes :
May be from special types of food ex :
Peanuts – strawberry – egg – shrimps
Drugs : sulpha drugs and penicillin
Latix or wool
Anaphylactic shock
Immune system over reacts to
hypersensitivity by releasing
chemicals that cause allergy
symptoms
The anaphylactoid reaction may
reach the layrnx and cause
laryngeal edema so the patient
Emergency Treatment
In case of angioedema and laryngeal edema and
most patients take it
Antihistamine + corticosteroid
Ex : avil amp ( pheniramine )+ solucortef
(hydrocortisone )amp
Dose : In children ½ amp of both
Solu cortef ( has rapid action )
Dexamethasone is 50 times more potent than
hydrocortisone it also has long acting effect
 Treatment
Corticosteroid topical + oral antihistamine
Topical steroid
Betnovate cream
Dose :2 times daily

Oral antihistamine
Fexon 120 mg tab
Dose : 1 tab before sleeping
 Herpes labialis
Viral infection , small vesicles may be filled with clear
fluid on lips or around mouth usually after common cold

Treatment :
Topical anti viral :
Acyclovir cream
Zovirax cream
Dose : 5 times daily until improvement
In case of 2ry infection
Antibiotics :
Fucidin cream
dose : 2 times daily
Duricef 500 caps
Dose : 2 times daily
Chicken pox
Highly contagious viral infection that usually occur in
children
Symptoms :
Early symptoms :
Fever , loss of appetitiy , head ache and generalized
weakness
Internal rash :
Red spots or ulcers in oral cavity or tonsils
Start before or with rash
Chicken pox
External rash
Polymorphic rash start with papule then
vesicle then crust usually associated with
itching
Start with face , trunk then limbs
Child is infectious 2 days before rash until
all lesions are crusted
Instructions
Avoid scratching to prevent 2ry bacterial
infection

Avoid contact with pregnant to prevent

infection as it can cause abortion or teratogenic
effect to the fetus

Avoid contact with other children

Treatment
Topical soothing agents :
Bringo lotion
Panthenol cream
Dose : 2 times daily

1st generation anti histamine

Tavagyl syp

2nd generation anti histamine

Zyrtec syrup
Topical antiseptic and antibiotic
K permenganate
Dose : apply using piece of cotton
Fucidin cream
Dose : twice daily
Thank you