New rosacea guidelines, dermatology compensation report, and are your patients choosing the right OTC topicals?

Thursday, May 28, 2020

Patients may be relying more on over-the-counter (OTC) skin care products during the current health crisis due to limited access to dermatologists. In this resident takeover, Dr. Daniel Mazori talks to Dr. Sophie Greenberg about selection of OTC topicals to avoid potential adverse effects. “I started looking into regulation and safety data and realized there’s a gap in formal treating on this topic, so I wanted to provide a guide to residents so they can be adequately informed,” Dr. Greenberg explains. They discuss how the Food and Drug Administration categorizes and regulates OTC products as well as resources to learn more about common ingredients in OTC topicals.

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We also bring you the latest in dermatology news and research:

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Things you will learn in this episode:

  • Choosing the wrong OTC products can cause or exacerbate skin conditions, such as allergic contact dermatitis, eczema, and acne, or even result in systemic toxicity.
  • The FDA categories for OTC products that are most relevant to dermatology include drugs (both prescription and nonprescription medications), cosmetics, soaps, and dietary supplements. Each category has its own unique set of regulations.
  • Drugs include topical steroids, antibiotic ointments, acne treatments, antifungals, and sunscreens. “Most of these products were previously available by prescription only but became available over-the-counter after sufficient postmarketing safety information,” says Dr. Greenberg.
  • Regulations for chemical sunscreens currently are in flux in light of data that demonstrate serum levels above the FDA limit for drugs that are exempt from further testing for carcinogenicity.
  • The FDA prohibits use of 11 categories of ingredients in all cosmetics but does not require approval, testing, or disclosure of safety data prior to products going to market. “A lot of patients and lay public have expressed concerns over the safety of over-the-counter [cosmetics], especially since regulation varies across the world,” Dr. Greenberg notes.
  • It is important to be vigilant and educate patients about imported cosmetics containing ingredients such as clobetasol that can be harmful if used incorrectly. “When we prescribe [products containing these ingredients], we have a chance to counsel patients on how to properly use [them], but the fact that people can purchase them over-the-counter is very scary,” Dr. Greenberg says.
  • Soap is categorized independently by its ingredients and its intended purpose to be used as a cleansing agent.
  • The FDA evaluates safety and labeling of dietary supplements before marketing but does not directly test these products. “Clinicians can refer patients to third-party agencies that verify ingredients and test for contaminants. ... since there have been reports of supplements not containing the ingredients that they said they contain or containing toxins or potential allergens,” Dr. Greenberg explains.
  • The Environmental Working Group’s Healthy Living app allows users to scan a product’s barcode to see all of its ingredients and safety rating.
  • Clinicians can scan pharmacy aisles to familiarize themselves with available OTC products and also try products on themselves to better understand and address patient concerns. “You can get samples at conferences or purchase different products each time you restock your own supply,” Dr. Greenberg recommends.

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Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn)

Guests: Sophie A. Greenberg, MD (Columbia University Medical Center, New York)

Disclosures: Dr. Mazori reports no conflicts of interest. Dr. Greenberg reports no conflicts of interest.

Show notes by: Alicia Sonners, Melissa Sears

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Podcast Participants

Vincent A. DeLeo, MD
Vincent A. DeLeo, MD, is from the Keck School of Medicine of the University of Southern California, Los Angeles, and the Icahn School of Medicine at Mount Sinai, New York, New York. He also is the editor in chief of Cutis and the author of more than 200 publications. He is a leading expert on contact dermatitis, sunscreens, and photosensitivity. Dr. DeLeo is a consultant for Estée Lauder.