Go easy on medicated lotions, creams, gels

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Go easy on medicated lotions, creams, gels Story Highlights

By Goldman

http://www.cnn.com/2008/HEALTH/02/05/healthmag.creams/index.html

Lidocaine, methyl salicylate, hydrocortisone. You probably don't

think twice about using over-the-counter creams with these

ingredients when you need to soothe a sore muscle or bug bite, prep

your legs before hair removal, or combat that vaginal itch. If the

product's available without a prescription, it can't hurt you, right?

Wrong.

One study estimates that women apply 175 chemicals a day from

cosmetics, creams, and toiletries alone.

Take Arielle Newman, for instance, a New York City-area high school

track star who died last year from a sports-cream overdose. She'd

used large amounts of popular OTC pain-relieving ointments like Icy

Hot and Ben-Gay on her sore muscles. The key ingredient in such

products is methyl salicylate, which built up in Newman's body, may

have interacted with other aspirin-based meds she was using, and

caused her to go into cardiac arrest.

Another case: In 2005, Shiri Berg, 22, of North Carolina died of a

lidocaine overdose. Following the instructions she'd been given by

the staff at a local hair-removal clinic, she generously applied a

numbing gel to her legs, then covered them in plastic wrap. On her

way to the clinic to get hair lasered from her legs, Berg passed out.

She went into convulsions, then a coma. Eight days later, she was

dead.

Women dying in the name of hair removal? Athletes putting themselves

at risk by using mentholated muscle soothers? Extreme situations, to

be sure. But with all the stuff each of us slathers on our skin (one

study estimates that women apply 175 chemicals a day from cosmetics,

creams, and toiletries alone), it's no surprise that potential

hazards are lurking.

Your skin is designed to protect you from countless insults: from air

pollution to murky lake water, from dirty gasoline-pump handles to

staph. Skin cells provide a physical barrier, sort of like bricks and

mortar, to keep the bad stuff out -- most of the time, says Francesca

J. Fusco, M.D., assistant clinical professor of dermatology at the

Mount Sinai School of Medicine. " The cells aren't as tightly packed

as real bricks, though, which means things can squeeze by and

pentrate. " That's good news if you want, say, an antiaging wrinkle

cream to wage war against your crow's feet or an anti-itch product to

tackle that exercise-induced rash on your inner thighs. Bad news when

strong chemicals meet sensitive or thin skin, cause an allergic

reaction, or dangerously flood your bloodstream.

Here, we investigate 14 ingredients commonly found in products you

may be using right now -- and we tell you how to stay safe.

Methyl salicylate

Most OTC muscle creams (including Ben-Gay, Icy Hot, and Tiger Balm)

contain one or more of three main ingredients: the cooling agents

menthol and camphor, and the pain reliever methyl salicylate. The

last one is similar to topical aspirin, says Matt Zirwas, M.D.,

director of The Ohio State University Medical Center Contact

Dermatitis Center. And what happened to track-star Newman is

essentially the same thing that could happen with an aspirin

overdose, he says.

The safe way to use muscle creams? Rub a small amount (about the size

of a quarter) into the painful muscle or joint area not more than

three or four times a day to prevent accumulation. If you're applying

more than a four-ounce tube a week, that's probably too much, Zirwas

says. And watch your aspirin intake -- too much can increase your

risk of overdose (in addition to the creams, Newman may have been

using a pain-relieving patch and taking aspirin), as can wrapping or

using a heating pad on ointment-covered skin.

Rubs with methyl salicylate may also interact with blood-thinning

prescription drugs, such as Plavix or Coumadin, used to prevent blood

from clotting, says J. Krabak, M.D., sports-medicine physician

at the University of Washington's department of rehabilitation

medicine. Because of its toxicity, any product containing 5 percent

or more of methyl salicylate (also called wintergreen oil) has to

carry a warning label stating it must be used as directed and kept

out of children's reach.

Lidocaine, benzocaine, tetracaine

If you've ever numbed a mole before the doc removed it or undergone

laser hair removal, you've probably used a topical anesthetic that

contains one of the " caines " -- lidocaine, benzocaine, or tetracaine -

- which are commonly used in various strengths in medical and

cosmetic situations. Most OTC types contain small amounts (less than

5 percent) of numbing ingredients and should be safe when used

according to package instructions, experts say.

There are dangers, however, if your skin is too numb to detect that

it's being harmed. If you have no feeling at all during a bikini wax

or hair lasering, for instance, you won't be able to tell whether the

wax is too hot or the laser is too strong.

An allergy is also possible, particularly when using vaginal-itch

treatments with benzocaine, Zirwas says. A benzocaine product may

temporarily help the problem, he says, " but a half-hour or an hour

later, the itching will return -- often worse -- so women apply more

cream, " he says. " Sometimes we see patients who are using these

creams 10 times a day. " The results can be a severe vaginal rash.

Zirwas' advice: " If the itch comes back an hour after you apply the

cream or if you develop a rash, suspect that you have a benzocaine

allergy and see a doctor. "

When topical anesthetics are seriously overused, there can be big

trouble. Shiri Berg applied a product called Lasergel Plus 10/10, a

powerful anesthetic containing 10 percent lidocaine and 10 percent

tetracaine. Experts have said the gel, a prescription-strength

compound given to the 22-year-old without a prescription by a hair-

removal spa, was too strong and applied over too large an area for

Berg's system to handle. After her death, the Food and Drug

Administration pointed out that risks rise when a topical anesthetic

is left on the skin for extended periods of time or applied to broad

portions of the body, especially if a bandage, plastic, or another

type of dressing is used as a covering. This is exactly what Berg

did, not knowing either the strength of the product she was using or

that there was any danger. Even more surprising: Berg was not the

first woman to die from the overzealous use of numbing cream. Blanca

Bolanos, a 25-year-old from Tucson, Arizona, suffered a similar fate

(convulsions, then a two-year coma ending in death) after using a

cream of 6 percent each lidocaine and tetracaine prior to laser hair

removal.

The safe way to use numbing creams? Apply them sparingly -- use as

little as possible, most experts say. And always know the ingredients

in and the strength of the product. Click here for tips on correctly

applying creams.

Hydrocortisone

An anti-inflammatory topical steroid that shrinks swollen tissue by

constricting blood vessels, hydrocortisone is often used to stop the

itching caused by chronic skin conditions like eczema and contact

dermatitis, and it's also an ingredient in vaginal and hemorrhoidal

creams. OTC topical steroids can contain just 1 percent

hydrocortisone, which should be safe, says Dina D. Strachan, M.D., a

dermatologist in private practice in New York City.

Be careful, though, when applying the creams to sensitive spots such

as the eyelids, armpits, and groin (all places where eczema, rashes,

and allergic reactions are particularly common). In these locations,

skin is thinner and more folds exist, so skin hits skin often, which

can cause medications to penetrate more deeply. These areas are also

prone to stretch marks, irritation, hypopigmentation (lightening),

and " a crinkly, cigarette-paper appearance, " Strachan explains -- a

good reason to avoid that old beauty-queen trick of using

hemorrhoidal cream to de-puff eye bags, experts say. In fact, last

year the makers of Preparation H issued a warning cautioning

consumers to avoid applying hemorrhoid cream to the face. Health.com:

The year's best beauty products

Overuse of topical steroids containing hydrocortisone can cause the

skin to develop a resistance (called tachyplaxis) to the medication,

says Behroozan, M.D., dermatologic surgeon and founder of the

Dermatology Institute of Southern California, and clinical instructor

at the University of California, Los Angeles, School of Medicine. As

a result, " in order to have the desired medical effect, a stronger

and more potent steroid may be needed, which may cause more potential

side effects. "

Estrogen

Women experiencing vaginal itching and irritation due to menopausal

changes sometimes turn to OTC products that contain estrogen, a

practice that worries Wen Shen, M.D., assistant professor of

gynecologic specialties at the s Hopkins University School of

Medicine. " Such creams get absorbed through the skin and metabolized

into estrogens in the body. That means they can cause the same side

effects as estrogen pills, such as elevated blood pressure, breast

tenderness, increased risk of breast cancer, abnormal vaginal

bleeding, and endometrial hyperplasia, which can lead to uterine

cancer, " she says. " If a woman is thinking about using anything with

estrogen, she really needs to get it through her physician. "

The same goes for OTC progesterone creams used to treat PMS and

menopause symptoms, says Krychman, M.D., medical director of

sexual medicine at Hoag Hospital in Newport Beach, California. " You

have to be very careful. You don't always know how much you're

getting or how much you're absorbing with these products, " he

says. " That makes it very easy to get too much. " A lot of women who

are trying these OTC creams on their own may not even have lowered

hormone levels, at all, he says. Consult your doctor before using.

Hydroquinone

Want to " fade away " those age spots? Be careful if you're thinking of

using hydroquinone, a popular ingredient in products claiming to

lighten age spots, melasma (excessive pigmentation usually caused by

the sun), or postinflammatory hyperpigmentation (a condition that can

afflict darker-skinned women). Such products are often available over

the counter but should be used only under a doctor's supervision,

Francesca J. Fusco, M.D., says. Ironically, in certain skin types the

opposite -- ochronosis, or darkening of the skin -- can occur. In

many cases, this happens in darker-skinned individuals, she says,

adding that hydroquinone has been under FDA investigation for

discontinuation in OTC products because of possible cancer-causing

activity in rats exposed to large amounts. Health.com: How I beat

hypochondria

Dihydroxyacetone (DHA)

Wonder why self-tanners have such a distinctive scent? It's the

dihydroxyacetone (DHA), a sugar derived from plants like beets and

sugarcane, that combines with your body's chemistry to produce

a " tan " and the smell. The odor won't hurt you, but the tan might --

if you're thinking of getting hair lasered from your darkened skin.

" Lasers work by detecting pigment, " Fusco says. That's why laser hair

removal works best on people with a good degree of contrast between

their hair and skin, such as fair-skinned women with dark hair. " The

stains in self-tanners can throw off the laser, leaving you with

first- or second-degree burns or discolored skin, " she explains. As a

caution, allow self-tanned skin about a week to fade before going in

for a laser procedure.

Vitamin A, glycolic acid

Retin-A and other vitamin A-based products (such as glycolic acid)

are often used to treat acne, as well as to reduce the appearance of

wrinkles by boosting collagen production. The downside: They thin the

very top layer of skin, which can make you more sensitive to sunlight

and to procedures like chemical peels, phototherapy (light

treatments), or even a simple eyebrow waxing. If you're scheduled

for, say, a waxing or a peel, it's a good idea to stop using any

vitamin A-based products one week prior; and don't resume for another

week. Also, avoid blackhead-removing strips, which can remove a top

layer of skin more easily while on such medications. And check in

with your doctor to be on the safe side.

Neomycin, bacitracin

Strangely, one of the treatments most often recommended to help heal

burns, stitches, and other wounds is now thought to cause an allergic

reaction in up to 10 percent of users. For those people, neomycin or

bacitracin, the active ingredients in products like Neosporin, may

cause an inflammatory reaction, angering the wound and making it

appear infected. The result: A minor cut can take even longer to heal

and have a potentially adverse cosmetic outcome, Behroozan says. " For

that reason, most dermatologists are now avoiding products with

neomycin and recommending plain Vaseline or Aquaphor Healing Ointment

for superficial wounds, " he says. " They promote a moist environment

for better wound-healing without potentially causing allergic contact

dermatitis. "

Paraphenylenediamine (PPD)

Ever get a temporary tattoo on a beach vacation? Many of them are

made with " black henna, " which contains paraphenylenediamine, or PPD,

a strong allergen that's also in hair dye. If you've had a product

with this chemical applied to your skin directly, as is done with a

tattoo, you're at risk of developing a strong allergy later from hair

dye. " You can have a horribly intense reaction, " Zirwas says. " I've

seen people hospitalized for up to a week -- eyes swollen shut, lips

swollen, too. " Zirwas estimates that just 2 percent of women will

develop an allergy to hair dye, but everyone should do a patch test

when coloring hair at home and look for PPD-free dyes.

Betaine

Very gentle shampoos often contain a lathering agent called betaine,

and they're fine for about 99 percent of the U.S. population. But for

the approximately 1 percent who develop a betaine allergy, even a

product created for the most sensitive skins can cause a red rash

around the eyes and along the neck, with flaking, peeling, and

itching. If you have this kind of contact dermatitis that just won't

go away, try betaine-free products such as Free & Clear shampoo,

Cetaphil soap, or Head & Shoulders shampoo, Zirwas says.

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