1. OTC Products For
Skin Disorders
Made by alaa belal

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

3. Fungal Infections

4. 5 Tinea Types Pedis Corporis Capitis Unguium Versicolor
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Versicolor

5. 1- Tinea pedis Athlete’s foot NOT just athletes !! But also:
Weak immune system
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Older than 60
Diabetics

6. 1- Tinea pedis Athlete’s foot Interdigital Moccasin Vesicular
Most common type
Itching
Scaling
Maceration & Foul odour
Between two smallest toes
Burning

7. 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

8. 1- Tinea pedis Athlete’s foot Interdigital Moccasin Vesicular
Least common
Fluid-filled blisters
Patient can not walk
Itching
Scaling

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

10. 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

11. 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

12. 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

13. 4- Tinea capitis Ringworm of the scalp Round, bald patches
More common in children
Scaling, itching

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

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

16. Differential diagnosis
Tinea versicolor
Vitiligo
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

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

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

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

20. Transmission of tinea
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Autoinfection

21. Treatment

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

23. Pharmaceutical Treatment
Most fungal infections
Topical OTC
cream, solution, spray, powder
Scalp
Except
Oral prescription
Nail
Most fungal infections topical OTC
cream , solution ,spray , powder
But :
1) nail 2)scalp oral prescription
Example :itraconazole (sporanox ®) and fluconazole (diflucan ®), terbinafine (lamifen®)
Disadvantages of oral antifungal:
1)most very expensive. (lamifen52 LEsporanox 42LE diflucan 1 tablet for 27LE )
2) side effects. contraindicated in patients with liver or heart problems.

24. Oral prescription Itraconazole Most fungal infections topical OTC
cream , solution ,spray , powder
But :
1) nail 2)scalp oral prescription
Example :itraconazole (sporanox ®) and fluconazole (diflucan ®), terbinafine (lamifen®)
Disadvantages of oral antifungal:
1)most very expensive. (lamifen52 LEsporanox 42LE diflucan 1 tablet for 27LE )
2) side effects. contraindicated in patients with liver or heart problems.

25. Oral prescription Fluconazole Most fungal infections topical OTC
cream , solution ,spray , powder
But :
1) nail 2)scalp oral prescription
Example :itraconazole (sporanox ®) and fluconazole (diflucan ®), terbinafine (lamifen®)
Disadvantages of oral antifungal:
1)most very expensive. (lamifen52 LEsporanox 42LE diflucan 1 tablet for 27LE )
2) side effects. contraindicated in patients with liver or heart problems.

26. Oral prescription Disadvantages Very expensive Side effects
Most fungal infections topical OTC
cream , solution ,spray , powder
But :
1) nail 2)scalp oral prescription
Example :itraconazole (sporanox ®) and fluconazole (diflucan ®), terbinafine (lamifen®)
Disadvantages of oral antifungal:
1)most very expensive. (lamifen52 LEsporanox 42LE diflucan 1 tablet for 27LE )
2) side effects. contraindicated in patients with liver or heart problems.

27. Treatment of nail infection (Tinea unguium)
Refer to a dermatologist if
Under 18 years
More than 2 infected nails
peripheral circulatory disorders
Unrespon-siveness treatment
Nail dystrophy or destruction
Pregnancy or breast feeding
diabetes mellitus
Deficiency in immune system

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

29. Nail polish
Cleaning
Cutting
Apply
Twice daily, for 3 months

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

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

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

33. 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

34. Tinea versicolor
Tinea capitis
Tinea unguium

35. Treatment Azoles Allylamines Clioquinol Undecylenic acid
Miconazole nitrate 2%
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine

36. Treatment Azoles Allylamines Clioquinol Undecylenic acid
Ketoconazole 2%
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine

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

38. Treatment Azoles Allylamines Clioquinol Undecylenic acid
Tolnaftate 1%
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine

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

40. Treatment Azoles Allylamines Clioquinol Undecylenic acid
Terbinafine 1%
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine

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

42. Treatment Azoles Allylamines Clioquinol Undecylenic acid
Salt of aluminium clioquinol 3%
Thiocarbamates
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine
Clioquinol + corticosteroid

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

44. Treatment Azoles Allylamines Clioquinol Undecylenic acid
Thiocarbamates
Undecylenic acid 10% and 25%
Allylamines
Fungistatic
Clioquinol
Undecylenic acid
Ointment at nighttime
Povidone iodine
Powder at daytime

45. Povidone iodine 10%solution (Betadaine®)
Treatment
Azoles
Thiocarbamates
Povidone iodine 10%solution (Betadaine®)
Allylamines
Clioquinol
Undecylenic acid
Povidone iodine

46. Candidiasis

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

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

49. Treatment
Topical oral antifungal
1- Miconazole
2- Nystatin

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

51. Treatment
2- Nystatin

52. VS ?? “ ” Quiz Oral gel 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 ”

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

54. Contraindication
liver disfunction
safety not assured

55. Canker sores
Aphthous stomatitis

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

57. Canker sores is an idiopathic disease
Cause
Unknown
Canker sores is an idiopathic disease

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

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

60. 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

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

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

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

64. Topical oral analgesic
Mundisal® gel

65. Topical oral analgesic
BBC® spray

66. Anti-inflammatory
Kenalog® in orabase

67. Antiseptic and disinfectant agent
Corsodyl® dental gel as chlorhexidine digluconate

68. The magic drug
Self Healing

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

70. Skin infestations

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

72. 4 Symptoms Itching Scabies 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

73. Transmission ( Why do you think? ) Direct way Indirect way
Scabies
Transmission
Direct way
Indirect way
Prolonged skin-to skin contact
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? )

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

75. 4 Symptoms Head lice 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?!)

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

77. Pediculicides/scabicides
Treatment
Pediculicides/scabicides
Antipruritics
Permethrin
Topical antipruritics
Malathion
Systemic antihistaminics
Piperonal
d-phenothrine

78. Permethrin Scabies Pediculosis 2.5-5% Permethrin Up to 1% Permethrin
Treatment
Permethrin
Scabies
Pediculosis
2.5-5% Permethrin
Up to 1% Permethrin
Permethrine®
Ectomethrine®
licid®

79. Malathion 0.5 lotion d-phenothrine 0.4%
Treatment
Malathion 0.5 lotion
(Ovide®)
d-phenothrine 0.4%
(Item shampoo)
Eradication of lice & nits from the scalp (head lice).

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

81. Pediculicides/scabicides
Treatment
Treatment
Pediculicides/scabicides
Antipruritics
Permethrin
Topical antipruritics
Malathion
Systemic antihistaminics
Piperonal
d-phenothrine

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

83. Viral Cutaneous Infections

84. 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.

85. 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.

86. Treatment
Acyclovir
Zovirax
Penciclovir

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

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

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

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

91. 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

92. Treatment ??

93. Refer to a dermatologist
diabetes mellitus
oozing purulent materials
Refer to a dermatologist
peripheral circulatory disease
rheumato-id arthritis
hemorrha-ging
Hair growth

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

95. NSAIDs Precautions Avoid using salicylic acid, if you are allergic to
(aspirin, ibuprofen, ….); or if you have any other allergies

96. Secondary Bacterial Infection
SBI

97. Which bacteria causes SBI
Staphylococcus aureus
Streptococcus pyogenes

98. Staphylococcus aureus
Impetigo (school sores)

99. Staphylococcus aureus
Folliculitis

100. Staphylococcus aureus
Furunculosis (boils)

101. Which bacteria causes SBI
Staphylococcus aureus
Streptococcus pyogenes

102. Streptococcus pyogenes
Cellulitis

103. Streptococcus pyogenes
Erysipelas

104. Streptococcus pyogenes
Necrotising fasciitis

105. Treatment Bacitracin Zinc Neomycin Polymyxin B Sulfate Tetracycline
Fusidic acid

106. Tetracycline
Fusidic acid
Terramycin
Fucidin

107. Thanks