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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
Athletes foot
NOT just
athletes !!
But also:
Weak immune system
Older than 60
Diabetics
1- Tinea pedis
Athletes foot
Interdigital Moccasin Vesicular

Most common type Itching Scaling Maceration & Foul odour


Between two smallest toes Burning
1- Tinea pedis
Athletes 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
Athletes 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, Grows outwards, may overlap
middle part normal 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 silvery-
white scales
Painful and sometimes crack &bleed
Similarities:
Itching Scaling
4- Tinea capitis
Ringworm of the scalp

Round, bald patches More common in children


Scaling, itching
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 Vitiligo

Flat Found on fingers, toes, knees, and


Hypo- or hyperpigmentation around the eyes and mouth
Slight itching and scalling Loss of all color (depigmentation)
Not painful
No scaling
Transmission of tinea
Prevention
1. Dry off well
2. Do not wear
occlusive clothes
3. 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

Scalp
Except Oral prescription
Nail
Oral prescription
Itraconazole
Oral prescription
Fluconazole
Oral prescription

Disadvantages

Very expensive Side effects


Treatment of nail infection
(Tinea unguium)
Referif to a
dermatologist
More
peripheral Unrespon-
Under than 2 siveness
circulatory
18 years infected disorders treatment
nails

Nail Deficiency
Pregnancy
dystrophy diabetes
or breast in immune
or mellitus
destruction feeding 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
Swollen mass
Severe tender
discharging
alopecia lymphocyte of
pus
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
Miconazole nitrate 2%
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Treatment
Azoles
Ketoconazole 2%
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Treatment
Azoles Available in all dosage
forms
Thiocarbamates Broad spectrum antifungal
Allylamines Apply twice daily
2 weeks for skin infection
Clioquinol 4 weeks for foot
6 weeks for scalp
Undecylenic acid few months for nail infection
Miconazole (Daktarin) safe
Povidone iodine in pregnancy
Treatment
Azoles Tolnaftate 1%
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Treatment
Azoles
Thiocarbamates Cream and
solution only
Allylamines Effective against most
Clioquinol dermatophytes not
only t.versicolor or
Undecylenic acid candidiasis

Povidone iodine
Treatment
Azoles
Terbinafine 1%
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Treatment
Azoles
Cream, solution, spray
Thiocarbamates tablets (but not otc)

Allylamines Cream 1-2 times:


1 week for T.pedis
2 weeks for
Clioquinol T.corporis
T.versicolor
Undecylenic acid
Not for children <16 or
Povidone iodine breast feeding mothers
Treatment
Azoles
Salt of aluminium
Thiocarbamates clioquinol 3%

Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Clioquinol + corticosteroid
Treatment
Azoles
Lotion, cream, ointment
Thiocarbamates
Side effects of clioquinol:
Allylamines May cause itching,
allergic contact
dermatitis
Clioquinol Interfere with thyroid
function
Undecylenic acid
Do not use <2 years
Povidone iodine
Treatment
Azoles
Thiocarbamates Undecylenic acid 10%
and 25%
Allylamines
Fungistatic
Clioquinol
Ointment at nighttime
Undecylenic acid
Powder at daytime
Povidone iodine
Treatment
Azoles Povidone iodine
Thiocarbamates 10%solution
(Betadaine)
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Candidiasis
Candidiasis
Most common type of yeast infection

More than 20 species

Most common Candida 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

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

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

Then we will give our OTC consultancy

No other extreme conditions

Make sure its 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:
called
Microscopic mite Sarcoptes scabei
Scabies Symptoms

Itching

Red papular rash

Rash can also include vesicles


Secondary bacterial infection

Greyish pencil-like burrows

to appear in
Take from 4 to 8 weeks patients who have not been infected previously
to appear in
Take from 1 to 4 days Patients who have scabies before
Scabies

Transmission

Direct way Indirect way

Prolonged skin-to skin By sharing articles


contact

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 Uncommon way

By person-to-person contact. 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 Pediculosis
2.5-5% Permethrin Up to 1% Permethrin

Permethrine Ectomethrine 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 Systemic antihistaminic


Calamine lotion Crotamitone lotion 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 Feet callus

Repeated handling of an object


that puts pressure on the hand
Lack a central core 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


Grow on the soles of the feet
Rough, shaped like a dome,
and greyish-brown in color. Hard, thick patches of skin with
dark specks
Treatment

??
oozing
diabetes
mellitus
purulent
materials
Refer to a
dermatologist
peripheral rheumato-
circulatory id arthritis
disease

hemorrha- Hair
ging growth
Treatment
(keratolytic agent )

Mechanism of action :
It decreases ??
Salicylic acidadhesion
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