KNOW YOUR INGREDIENTS

The following notes (in aphabetical order) have been provided by Tony Accordino B Pharm, MPS, MBA, director of "Oxford Compounding" and by Dr Grant Masel.

Aluminium chloride

Aluminium chloride is soluble 1 in 0.9mL of water and 1 in 4 of ethanol. It may cause irritation especially if applied to damp skin; this is attributed to the formation of hydrochloric acid.

Aluminium chloride has astringent properties and is generally used as a 20% alcoholic solution as an antiperspirant in the treatment of hyperhidrosis. It is applied to dry skin usually at bedtime, and is was\hed off in the morning before the sweat glands are fully active. Initially, it may be applied each night until sweating improves, then less frequently, as required, to maintain efficacy.

Arachis (Peanut) oilL. Oleum Arachis

Most highly refined peanut oils remove the peanut allergens and have been shown to be safe for "the vast majority of peanut-allergic individuals".Cold-pressed peanut oils may not remove the allergens and thus could be highly dangerous to people with peanut allergy. Since the degree of processing for any particular product is often unclear, "avoidance is prudent" Peanuts that contain the mold that produces highly toxic aflatoxin can end up contaminating the oil derived from them. Arachis oil has properties similar to Olive oil, however, Olive oil is less prone to rancidity. In preparing emulsions of olive oil of low acid value with lime water for external use, a few drops of oleic acid may be necessary to produce sufficient calcium oleate to act as an emulsifying agent.

At the 1900 Paris Exhibition, the Otto Company, at the request of the French government, demonstrated that peanut oil could be used as a source of fuel for the diesel engine; this was one of the earliest demonstrations of biodiesel technology.

Aqueous cream

Is an oil in water cream that is the basis of many pharmaceutical preparations. It consists of an oil/wax combination of Cetostearyl alcohol, Liquid paraffin, White Soft Paraffin and the emulgent Sodium lauryl sulphate with phenoxyethanol as the preservative. Whilst it is lacks cosmetic elegance it remains as a mainstay as the base of many compounded dermatologicals.

Camphor

Applied externally, camphor acts as a rubifacient and mild analagesic. It is commonly used together with menthol at a concentration of 0.5%.

Boric acid

Boric acid is a feeble bacteriostatic and fungistatic and is mainly employed by external application as a weak antiseptic. It is used mixed with starch, or zinc oxide to treat eczematous and other skin conditions.

Burow's (AluminiumAcetate) solution

is a pharmaceutical preparation reacted to form aluminium acetate dissolved in water. It was invented in the mid-19th century by Karl August Burow, an ophthalmologist.

Calamine

Consists of a basic zinc carbonate, coloured with ferric oxide which yields a pink powder. It is used for its mild astringent action and antipruritic action. It is used as a dusting powder, cream, lotion or ointment.

Castellani, Aldo (Italian pathologist and bacteriologist)

Born 1877, Florence Italy. Died October 3, 1971 (aged 94)

Known for Castellani’s paint

Notable awards Honorary Knight Commander of the Order of St Michael and St George

Castellani was born in Florence and educated there, qualifying in medicine in 1899. He worked for a time in Bonn and joined the School of Hygiene and Tropical Medicine in London in 1901. As bacteriologist with the Royal Society Commission on Sleeping Sickness in 1902, he went to Entebbe, Uganda with George Carmichael Low and Cuthbert Christie. He demonstrated the cause and means of transmission of sleeping sickness, discovered the spirochete of yaws, and did other original work in bacteriology and in parasitic diseases of the skin. In 1903 he was appointed Bacteriologist to the Government of Ceylon at the Central laboratory in Colombo and continued research in mycology and bacteriology, describing several new species of intestinal bacilli. He invented the absorption test for the serological identification of closely allied organisms. He left Ceylon in 1915 for Naples where he took the Chair of Medicine. He was involved during World War I in Serbia and Macedonia as a member of the Inter-Allied Sanitary Commission.

In 1919 Castellani went to London as Consultant to the Ministry of Pensions.[2] He became lecturer on mycology and mycotic diseases at the London School of Hygiene and Tropical Medicine,[3] and established a consulting practice in Harley Street. He was knighted in 1928 as an Honorary Knight Commander of the Order of St Michael and St George [4] and in 1934 his daughter Jacqueline married Sir Miles Lampson.

Castellani's enthusiasm for Royal and eminent patients such as Benito Mussolini clouded his reputation and during World War II he supported Italy against the Allies, becoming chief of the Italian Army's medical service. War correspondent Alaric Jacob discovered his looted quarters in Cirene in December 1941 and was tempted to pass his correspondence to his son in law Sir Miles Lampson, then British Ambassador in Egypt.[5]

Castellani was President of the International Society of Dermatology from 1960–1964,[6], which he had founded in 1959. He was also professor of tropical medicine at the State University of Louisiana and also at the Royal University of Rome. He followed the Queen of Italy Marie José into exile in Portugal and ended his life as Professor at Lisbon's Institute of Tropical Medicine. Castellani died in 1971.[2] Castellani's paint (Carbol fuchsin solution) is still occasionally used to treat fungal skin infections.[7]

Cetostearyl Alcohol

Cetaphil lotion

Is a moisturising lotion suitable for dry, sensitive skin produced by Galderma. It contains the following ingredients; Purified water, Glycerol, hydrogenated polyisobutene, cetearyl alcohol, ceteareth-20, refined macadamia nut oil, alpha tocopherol acetate, cetostearyl alcohol, dimethicone, benzyl alcohol, sorbic acid, stearoxytrimethylsilane, stearyl alcohol, dexpanthenol, farnesol, carbomer 1342 and sodium hydroxide.

Cetrimide

Is soluble I in 2 of water and very soluble in alcohol. It is termed a quaternary ammonium compound or a cationic surface active agent. Solutions containing 0.1 to 1% are used for cleansing the skin, wounds and burns, often in combination with chlorhexidine to increase its spectrum of action. A 0.5% solution in alcohol 70% can be used for pre operative skin “sterilisation”. It is potentially incompatible with anionic drugs.

Coal tar (Crude Coal Tar, CCT)

Coal tar Is obtained by the destructive distillation of bituminous coal. It is a thick, nearly black, viscid liquid with a strong characteristic empyreumatic (smoky) odour. Coal tars are complex and variable mixtures of phenols, polycyclic aromatic hydrocarbons (PAHs), and heterocyclic compounds, about 200 substances in all.

"The use of medicinal tar for dermatologic disorders dates back to the ancient times. Although coal tar is utilized more frequently in modern dermatology, wood tars have also been widely employed. Tar is used mainly in the treatment of chronic stable plaque psoriasis, scalp psoriasis, atopic dermatitis, and seborrheic dermatitis, either alone or in combination therapy with other medications, phototherapy, or both. Many modifications have been made to tar preparations to increase their acceptability, as some dislike its odor, messy application, and staining of clothing. One should consider a tried and true treatment with tar that has led to clearing of lesions and prolonged remission times. Occupational studies have demonstrated the carcinogenicity of tar; however, epidemiologic studies do not confirm similar outcomes when used topically. This article will review the pharmacology, formulations, efficacy, and adverse effects of crude coal tar and other tars in the treatment of selected dermatologic conditions.

Tars have been used since the ancient times. Hippocrates first described the use of pine tar in medicine.¹ Coal tar was used for dermatologic conditions for well over 2000 years, when it was referred to as “asphalt” by Dioscorides, a Greek physician and pharmacologist.² More recently, therapeutic crude coal tar in dermatology was emphasized in 1681 by Becher and Serle.², ³ The renowned Professor Kaposi⁴ in Vienna noted in 1895 that an important part of his pharmacopoeia was played by tar. It was obtained from coals, stones, and several kinds of wood by dry distillation, including beech, birch, and Juniperus oxycedrus (oil of cade).

Over the past century, coal tar has also been used in the treatment of scabies, sarcoidosis, neurodermatitis, and pityriasis lichenoides chronica. Currently, it is employed mainly for chronic stable plaque psoriasis, scalp psoriasis, seborrheic dermatitis, and atopic dermatitis. In addition, we have also found it useful for neurodermatitis.³, ⁵, ⁶, ⁷ In 1925, Goeckerman first described the clinical efficacy of ultraviolet (UV) radiation combined with coal tar for the treatment of psoriasis, resulting in high clearance rates and long remission times.⁸ Although coal tar use has waned in western countries, it is still considered the first-line treatment in many parts of the world.⁶, ⁹ Tar is a proven remedy as evidenced by clinical experience and trials conducted on patients with various skin disorders. A PUBMED literature search revealed a deficit of new controlled clinical trials with tar, perhaps because of a lack of financial gain for manufacturers, concerns regarding carcinogenicity, and the introduction of newer, potentially more lucrative therapeutic modalities. Other tars, including wood tars, have been used in the treatment of these conditions; however, some believe they are not as efficacious as coal tar.¹⁰, the others being wood tar (principally pine, beech, birch, and juniper) and shale (bituminous tars/ichthammols).¹⁰ Wood and shale tars lack contact sensitizing potential and/or photosensitizing effects, both qualities that coal tar possesses. Coal tar is heavier than water and is slightly soluble in it, resulting in a mildly alkaline solution. It also has a naphthalene-like odor with a sharp, burning taste.¹¹ Coal tar is first made by heating coal in the absence of air with the gases that form allowed to cool into a brown-black liquid.² This is followed by the removal of ammonia, resulting in a product containing 10,000 compounds, including polycyclic aromatic hydrocarbons (PAHs), carbon, and water. The crude coal tar then undergoes fractional distillation, producing oils that can be mixed in various topical vehicles to increase the absorption of the coal tar.², ³ However, the final composition varies depending on the type of coal used and temperature of the distillation.¹² At lower temperatures, coal tar has an increased content of phenols and tar acids; at higher temperatures, coal tar has an elevated number of PAHs.² There are no agreed-on chemical or biological standards to determine the exact pharmacokinetics of coal tar because of the certain variability that is to be expected in the final formulation.¹al tar is not well understood. However, there are several possible effects, including suppression of DNA synthesis, leading to a reduction of epidermal hyperproliferation in psoriatic skin^. Conversely, it increases the mitotic rate labeling index and initially thickens the epidermis in healthy skin.¹⁰ This variance in activity may be because coal tar is correcting a defect in differentiation in psoriatic skin. In addition, antibacterial, antifungal, and antiparasitic actions have been described, as have antipruritic and anti-inflammatory effects.², ³ In animal studies, inhibition of sebum secretion was reported with the use of topical therapy.²

Table I. Possible mechanisms of action of coal tar

Also known as Anthralin. It is available as creams, ointment or pastes in 0.1 to 2% strengths .

Dithranol accumulates in mitochondria where it interferes with the supply of energy to the cell, probably by the oxidation of dithranol releasing free radicals. This impedes DNA replication and so slows the excessive cell division that occurs in psoriatic plaques. In addition Dithranol may act by reducing the elevated levels of cGMP that occurs in psoriasis. (citations?)

Anthralin is a synthetic compound whose precise mechanism of anti-psoriatic action is not yet fully understood. However, numerous studies have demonstrated anti-proliferative and anti-inflammatory effects of anthralin on psoriatic and normal skin. The anti-proliferative effects of anthralin appear to result from both an inhibition of DNA synthesis as well as from its strong reducing properties. Recently, anthralin’s effectiveness as an anti-psoriatic agent has also been in part attributed to its abilities to induce lipid peroxidation and reduce levels of endothelial adhesion molecules which are markedly elevated in psoriatic patients. Unlike retinoids and PUVA, anthralin does not inhibit liver microsomal enzyme activity; consequently, the likelihood of adverse drug interactions is greatly reduced when other agents are administered concomitantly with anthralin. (citations?)

More dithranol penetrates into impaired skin in 30 minutes than into intact skin during about 16 hours. For this reason weaker 0.1-0.5% preparations are applied overnight, but stronger 1-2% products are applied for between 30 minutes and one hour depending upon the formulation.[edit] Clinical considerations Dithranol has a slower onset of action in controlling psoriasis, typically several weeks, compared to glucocorticoid steroids, but is without the potential for rebound reaction on withdrawal. It cannot be used on the face or genitalia.[edit] Side effectsIt temporarily stains the skin a yellowy-brown and permanently stains clothing fabrics. It may cause a local burning sensation and irritation; this may be minimised by careful attention to the details of treatment and only gradually stepping up through the strengths of dithranol formulations. The surrounding skin can be protected using soft white paraffin and the treated area is covered with tube gauze.

"Anthralin..is highly effective and not associated with systemic side effects. Its drawbacks include irritation of the skin and staining of the skin and household items with which it comes in contact, including bathtubs, sinks, clothing, and linen. New regimens have been devised to minimize exposure to household items. The most commonly used regimen is called short-contact anthralin therapy and involves topical application of anthralin in high concentrations (up to 1% or higher) for anywhere from 5 to 30 minutes daily. ¹¹, ¹² This regimen was more readily accepted because it is as effective as overnight treatment with anthralin or prolonged treatment, as in the Ingram regimen. ¹³ Topical preparations have also been devised to remove the staining and minimize the irritation of anthralin. Triethanolamine is one of the products marketed for that purpose. ¹⁴ In addition, new formulations of anthralin have been devised to minimize staining. Most recently, a new preparation has been introduced that incorporates anthralin into a vehicle that only delivers the drug at the temperature of the body’s skin so that staining of household items is minimized (Micanol, Bioglan Pharma, Tampa, FL). ¹⁵

In a review of literature, the duration of remission after treatment with various anthralin regimens ranges from 3.9 to 6 months. ¹⁶, ¹⁷, ¹⁸ In one study of 58 children with psoriasis, dithranol cream (0.1% to 2%) was applied in a short-contact therapy regimen for 30 minutes. ¹⁶ It took a median of 2 months to achieve remission and this was obtained in 81% of patients. The median duration of remission was 4 months. Another group of authors looked at 315 patients treated for 10 to 20 minutes daily with 0.1% to 3% dithranol in a base that included 2% salicylic acid in white, soft petrolatum. ¹⁷ Patients were treated 10 to 20 minutes daily. Eighty-five patients participated in left-right comparisons to see whether prolongation of contact time to 1 hour or addition of topical corticosteroids provided additional benefit. Neither modification improved therapeutic results. Duration of remission lasted for an average of 3.9 months.

Statham, Ryatt, and Rowell ¹⁸ compared the duration of remission in patients treated with short-contact dithranol to a traditional Ingram regimen consisting of conventional anthralin applications in addition to UVB phototherapy. Forty-three patients were studied, and improvement was significantly faster in those treated with the Ingram regimen. The duration of remission did not differ between the 2 regimens. Twelve weeks after discontinuation of treatment, PASI scores were still reduced a mean of 66% in the short-contact group and 71% in the Ingram-treated patients.

Vella-Briffa et al ¹⁹ compared the relapse rate of psoriasis after clearing with either the Ingram regimen or PUVA. Without maintenance therapies, it was estimated that psoriasis returns to 50% of its baseline in approximately 6 months, on the average. Maintenance treatments with PUVA ranging from 1 per week to 1 every 3 weeks prolong the duration of remission."

from JAAD: Duration of remission of psoriasis therapies

John Koo, MD a,

Mark Lebwohl, MD b

San Francisco, California, and New York, New York

From the Department of Dermatology, University of California, San Francisco Medical Center, a and The Mount Sinai School of Medicine, Department of Dermatology, New York. b

Ethanols

Denatured alcohol or methylated spirits is ethanol that has additives to make it undrinkable (poisonous), to discourage recreational consumption. In some cases it is also dyed.

Denatured alcohol is used as a solvent and as fuel for spirit burners and camping stoves. Because of the diversity of industrial uses for denatured alcohol, hundreds of additives and denaturing methods have been used. The main additive has traditionally been 10% methanol, giving rise to the term "methylated spirit." Other typical additives include isopropyl alcohol, acetone, methyl ethyl ketone, methyl isobutyl ketone, and denatonium benzoate

Denaturing alcohol does not chemically alter the ethanol molecule. Rather, the ethanol is mixed with other chemicals to form an undrinkable solution.

Terms that are encountered are SVI (Spirit Vini Industrialis – meaning Industrial Alcohol, this is not to be confused with SVR (meaning Spirit Vini Rectificatus or Rectified Spirit) which is Ethanol diluted to a content of 90% by the addition of Purified Water. Ethanol BP (often referred to as Absolute Ethanol is 100% Ethanol)

Different additives are used to make it difficult to use distillation or other simple processes to reverse the denaturation. Methanol is commonly used both because its boiling point is close to that of ethanol and because it is toxic. In many countries, it is also required that denatured alcohol be dyed blue or purple with an aniline dye.

Erythromycin

Is a macrolide antibiotic produced by the growth of a strain of Streptomyces erythreus. It occurs as a white or slightly yellow powder or crystals. It is slightly soluble in water and freely soluble in alcohol. It may be used topically for mild inflammatory acne if benzoyl peroxide is ineffective or poorly tolerated.

Formaldehyde Solution (Formalin)

Formaldehyde solution is a bactericidal disinfectant also effective against fungi and many viruses. When applied to unbroken skinit hardens the epidermis, renders it tough and whitish and produces a local anaesthetic effect. As a 3% solution it has been used for the treatment of warts on the palms of the hands and soles of the feet.

Glycerol

It is often included in topical preparations such as creams and lotions as a lubricant and also for its moisturising properties since, when absorbed, its hygroscopic action can enhance moisture retention.

Glycolic acid

Glycolic acid is an alpha hydroxyl organic acid that has been used in topical preparations for hyperpigmentation and photodamaged skin.

Hydroquinone

Hydroquinone increases melanin excretion from melanocytes and may also prevent its production. It is used topically as a depigmenting agent for the skin in hyperpigmentation conditions such as chloasma, melisma, freckles and lentigines. Concentrations of 2 to 4% are commonly used; higher concentrations may be very irritant and increase the risk of ochronosis. It may be several weeks before any effect is apparent but depigmentation may last for 2 to 6 months after stopping. Application of hydroquinone should stop if there is no improvement after 2 months. Hydroquinone should be applied twice daily only to intact skin which should be protected from sunlight with a sunscreen to prevent repigmentation.

Ichthammol (Ammonium Bituminosulphonate)

An almost black viscous liquid with a strong empyreumatic (smoky) odour. It consists of the ammonium salts of the sulphonic schists of an oily substance prepared from the destructive distillation of bituminous schist or shale, together with ammonium sulphate (about 5 to 7%) and water

Pharmacologically, Ichthammol has anti-inflammatory, bactericidal and fungicidal properties. In otology, a mixture of glycerol and ichthammol has been used for generations for the topical treatment of ear infections. It is efficient against Gram-positive organisms. The anti-inflammatory action is explained by its influence on the formation, secretion and effect of inflammatory mediators. It is well tolerated and no indications of teratogenic, mutagenic or carcinogenic effects have been noted.

Albert Montgomery Kligman (March 17, 1916 – February 9, 2010) With financial support from Simon Greenberg, a major rabbi of the time, he attended Pennsylvania State University, earning a bachelor's degree in 1939 He went on to receive a Ph.D. in botany from the University of Pennsylvania in 1942, specializing in the study of fungi. He continued at the University of Pennsylvania, enrolling in its medical school, earning his M.D. in 1947. He chose dermatology as his specialty in order to apply his expertise in fungi. He went on to invent Retin-A, the popular acne medication. Kligman is best known for the medical research he performed on inmates at Holmesburg Prison in Philadelphia and the scandal it generated years later.

Kligman’s Formula is a prescription only formulation that consists of 5% hydroquinone, 0.1% tretinoin, and 0.1% dexamethasone in hydrophilic ointment. The combination is used to treat conditions involving hyperpigmentation – Melasma, age spots and scars.

Jessner's peel solution,

Formerly known as the Coombe's formula, was pioneered by Dr Max Jessner, a German-American dermatologist. Dr Jessner combined 14% salicylic acid, lactic acid, and resorcinol in an ethanol base. It is thought to break intracellular bridges between keratinocytes. It is very difficult to "overpeel" the skin due to the mild percentages associated with the acid combination.

Kojic acid

Kojic acid inhibits melanin production and is used in topical preparations for the treatment of hyperpigmentation disorders.

Lactic acid

Consists of a mixture of lactic acid, its condensation products, such as lactoyl-lactic acid, and other polylactic acids, and water. The equilibrium between lactic acid and polylactic acids depends on the concentration and temperature. It is usually the racemate (RS-lactic acid), and contains the equivalent of 88 to 92% w/w of C3H6O3.

It is used topically in the treatment of warts, often with salicylic acid, and in emollient creams.

Lanolin (Wool fat)

Wool fat resembles the sebaceous secretion of the human skin. By itself it is not rapidly absorbed, but when mixed with a suitable vegetable oil such as peanut (arachis oil) or with soft paraffin it gives emollient creams which penetrate the skin and thus facilitate the absorption of drugs.

Lime Water (Calcium Hydroxide Solution) add information

Menthol

Olive oil

Externally olive oil is emollient and soothing to inflamed surfaces, and is employes to soften the skin and crusts in eczema and psoriasis.

Phenol

Polysorbate 80

Is a hydrophilic non-ionic surfactant used as an emulsifying agent for the preparation of stable oil in water emulsions in pharmaceutical products and as a solubilising agent for essential oils and oil soluble vitamins. Also used as a wetting agent for insoluble agents such as Precipitated sulphur and Crude coal tar.

Paraffins: White soft paraffin (WSP) and Yellow soft paraffin (YSP)

Also referred to as (White or Yellow) Petrolatum which is a purified mixture of semisolid saturated hydrocarbons having the general formula C_nH_2n+2, and is obtained from petroleum. The hydrocarbons consist of branched and unbranched chains although some cyclic alkanes and aromatic molecules with paraffin side chains may be present. Petrolatum is mainly used in topical pharmaceutical formulations as an emollient-ointment base; it is poorly absorbed by the skin. It is also used in creams and transdermal formulations and as an ingredient in lubricant formulations for medicated confectionery together with mineral oil.

Therapeutically, sterile guaze dressings containing petrolatum may be used for non-adherentbwound dressings or as a packing material. It is also used widely in cosmetics and in some food applications.

Chesebrough Manufacturing Company was an oil business which produced petroleum jelly or vaseline[1], which was marketed with the brand name Luxor. It was founded in 1859. Robert Augustus Chesebrough, a chemist who started the company, was interested in marketing oil products for medicinal needs. He produced the first petroleum jelly by refining rod wax through the use of heat and filtration. He named it vaseline from the German language word for water, (wasser), and the Greek language word for oil, (olion). Vaseline was patented in the United States in 1872 and England in 1877.

Sir Robert Augustus Chesebrough, (January 9, 1837 – September 8, 1933) was a chemist and the inventor of petroleum jelly, which he trade-named as Vaseline. In 1875 he founded the Chesebrough Manufacturing Company that in 1955 became Chesebrough-Ponds, a leading manufacturer of personal care products. Chesebrough patented the process of making petroleum jelly (U.S. Patent 127,568) in 1872. Born in London, Chesebrough began his career as a chemist clarifying kerosene from the oil of sperm whales. The discovery of petroleum in Titusville, Pennsylvania rendered his job obsolete, so he traveled to Titusville to research what new materials might be created from the new fuel.

Chesebrough's success stemmed from firm belief in his product. Before Chesebrough began selling petroleum jelly, he tested it on his own cuts and burns. Having demonstrated the product's efficacy on himself, Chesebrough was still unable to sell any to drug stores until he travelled around New York State demonstrating his miracle product. In front of an audience he would burn his skin with acid or an open flame, then spread the clear jelly on his injuries while demonstrating past injuries, healed, he claimed, by his miracle product. To further create demand, he gave out free samples.

Chesebrough opened his first factory in 1870. The first known reference to the name Vaseline is in his U.S. patent: “I, Robert Chesebrough, have invented a new and useful product from petroleum which I have named 'Vaseline…'" . The etymology of the word is believed to come from German wasser (=water) + Greek έλαιον (=oil).

Cheseborough earned knighthood in 1883. Upon knighting him, Queen Victoria extolled his product's usefulness, proudly claiming that she "used Vaseline every day.

Chesebrough lived to be 96 years old and was such a believer in Vaseline that he claimed to have eaten a spoonful of it every day.[1] He died at his house in Spring Lake, New Jersey.[2] He also, reportedly, during a serious bout of pleurisy in his mid-50s, had his nurse rub him from head to foot with the substance. He soon recovered.[3]

Yellow Soft Paraffin to 100% also referred to as Paraffin Molle Flavum (PMF)

Purified Water also known as Aqua dest

Resorcinol

Externally, resorcinol has a marked anti-pruritic action and is employed in solution or as an ointment, usually with salicylic acid and zinc oxide, in the treatment of psoriasis, eczema and seborrhoeic conditions. Resorcinol is dangerous when appliedover large surfaces, especially when used in high concentrations

Salicylic acid

Is an aromatic hydroxy acid and is derived from benzoic acid, which has been used in combination with salicylic acid as Whitfield’s ointment for hyperkeratotic conditions and fungal infections. Salicylic acid is 2-hydroxybenzoic acid and may be called a hydroxy acid within a broad definition; however, its effects on skin differ from those of alpha hydroxy acids (AHA’s). Salicylic acid is a conventional keratolytic agent which desquamates corneocytes, layer by layer from the top downward. In contrast AHA’s appear to act at the innermost layers of the stratum corneum, stratum compactum, near the junction with the stratum granulosum.

Salicylic acid has keratolytic properties and is applied topically in the treatment of hyperkeratotic and scaling skin conditions such as dandruff and seborrhoeic dermatitis, ichthyosis, psoriasis, and acne. Preparations usually range between 2 to 6%, but a wider range of concentrations has been used. It is often used with other drugs, notably coal tar. Preparations containing up to 60% salicylic acid have been used as a caustic for the removal of plantar warts, corns or calluses; surrounding skin should be protected.

Salicylic acid also possesses fungicidal properties and is used topically in the treatment of dermatophyte skin infections.

Starch

Obtained from maize, rice, wheat, potato and is a fine white odourless powder. It is added to formulations such as dusting powders or ointments as an absorbent, either alone or mixed with boric acid and zinc oxide.

Sucralfate

Is the hydrous basic aluminium salt of sucrose octasulfate. It has been used as a mouth rinse in the treatment and prophylaxis of stomatitis induced by cancer chemotherapy.

Sulphur

Sulphur is a keratolytic, a mild antiseptic, a mild antifungal, and a parasiticide. Precipitated sulphur is commonly used in pharmaceutical compounding as it has a smaller particle size than sublimed sulphur. Sulphur has been widely used in lotions, creams, or ointments, in concentrations of up to 10% usually combined with other agents, in the treatment of acne, dandruff, seborrhoeic conditions, scabies, and superficial fungal infections.

Talc: Purified

Is otherwise known as Talc, Purified, French Chalk and Talcum. It is a purified native magnesium silicate and may contain a small amount of aluminium silicate. To avoid the risk of tetanus, purified talc used in pharmaceuticals is supplied as a sterilised powder. It is used topically in dusting powders and ointments to allay irritation and prevent chafing. It is usually mixed with starch and zinc oxide or with small amounts of boric acid. It is no longer used as a lubricant for surgical gloves since purified talc is liable to cause foreign body granulomas.

Tincture of Benzoin (Tinc Benz Co)

Benzoin is a naturally occurring compound derived from plants referred to as vegetable gums or balsams.1 It is a balsamic oleoresin, a mixture of both resin and volatile (essential) oils.2 Benzoin is a common designation for various solid resins differing in composition and odour. Benzoin, like balsam of Peru, is a pathological secretion formed only after lesions to the bark of the tree.3

Among the commercial preparations, the most important are Siam benzoin and Sumatra benzoin, which are derived from different plants found in different countries.3Styrax tonkinensis is the source of Siam benzoin. This preparation is sometimes called Friars' balsam. Sumatra benzoin is less allergenic and is the form used for inhalations. It is derived from other species including Styrax benzoin and Styrax paralleoneurus.4,5 The composition in various pharmaceutical preparations is the same, whether Siam or Sumatra benzoin is used.3

Compound tincture of benzoin (CTB) is a mixture made of four naturally occurring resins: benzoin, aloe, storax and tolu balsam in alcohol; whereas tincture of benzoin consists of 10% benzoin in alcohol (Table 1).6 Compound tincture of benzoin can also contain myrrh and angelica, and occasionally balsam of Peru.3,4 Balsam of Peru, benzoin, storax and tolu, are all balsamic oleoresins. Benzoin can cross-react with balsam of Peru, storax, eugenol, vanilla, alpha-pinene, benzyl alcohol and benzyl cinnamate, as they are all similar in chemical structure.6

Tetracaine HCl

Tetracaine Hydrochloride, a para-aminobenzoic acid ester, is a potent local anaesthetic. It produces anaesthesia within approximately 30 seconds and lasts up to 15 minutes or longer. It can be used as a mouthwash in the treatment of severe aphthous ulceration, advising the patient not to swallow the solution after rinsing the mouth cavity for 1 to 2 minutes.

Tretinoin

Preparations containing 0.02 to 0.05 % are used for the treatment of mottled hyperpigmentation, roughness, and fine wrinkling of photodamaged skin. It is generally applied once daily at night, often in combination with other depigmenting agents such as Hydroquinone and Kojic acid.

Witch Hazel (Hamamelis)

The leaves and bark of the North American Witch-hazel Hamamelis virginiana may be used to produce an astringent,[9] also referred to as witch hazel, and is used medicinally. This plant extract was widely used for medicinal purposes by American Indians and is a component of a variety of commercial healthcare products.[9]

It's mainly used externally on sores, bruises, and swelling. Witch hazel hydrosol is used in skin care. It is a strong anti-oxidant and astringent, which makes it very useful in fighting acne.[9] It is often used as a natural remedy for psoriasis, eczema, aftershave applications, ingrown nails, to prevent sweating of the face, cracked or blistered skin, for treating insect bites, poison ivy, and as a treatment for varicose veins and hemorrhoids.[10] It is found in numerous over-the-counter hemorrhoid preparations.[

Zinc oxide

Is a soft, white or faintly yellowish-white, odourless, tasteless powder, with the superior or micronized grades being free of grittiness. It is applied externally as a mild astringent for the skin, as a soothing and protective application in eczema, and as a protective to slight excoriations.